Vesicovaginal fistula (VVF) is a distressing complication that can arise following gynecological surgeries, leading to significant morbidity. We present a case of VVF in a 40-year-old female who underwent robot-assisted total laparoscopic hysterectomy with bilateral salpingectomy and partial cystectomy for endometriosis in September 2023. Despite initial management, the patient developed a refractory VVF requiring surgical intervention.

The patient underwent robot-assisted VVF repair via a pneumovesical approach. A 3 cm low midline incision was made, and the Da Vinci SP robotic system was utilized. The patient was positioned in modified lithotomy with slight Trendelenburg. Peri-fistula tissue was dissected, and the mucosa surrounding the fistula was debrided. The vaginal defect was repaired using Vicryl 4-0 sutures in a layered fashion, followed by reconstruction of the bladder mucosa. Bilateral jetting was confirmed intraoperatively, and a Foley catheter was placed.

The operation lasted 90 minutes with minimal blood loss. The patient recovered uneventfully and was discharged on postoperative day 7. The Foley catheter was removed after confirming the absence of leakage using cystography.

Robot-assisted VVF repair via a pneumovesical approach demonstrates effective surgical management with meticulous tissue handling and successful postoperative outcomes.