Introduction: Background and purpose: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 57 year old man underwent open radical prostatectomy with recognized rectal injury, primary closure of the rectal wall, and loop colostomy. The patient developed urine leakage per rectum after colostomy closure. The fecal stream was once again diverted with end colostomy, and a suprapubic tube was placed. An open trans-sacral (Kraske) repair failed 1 month later. We have previously described the laparoscopic approach, and herein describe the technique and results of our first robotic assisted operation.

Methods: Technique: The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic initial dissection (4) mobilization of omental pedicle flap, (4) cystotomy extending towards to the fistulous tract, (5) Robot docking (6) dissection of the rectovesical plane, (7) interrrupted rectal closure, (8) interposition of omentum, (9) bladder closure, (10) drain placement.

Results: Operative time was 180 minutes. Hospital stay was 1 day. The suprapubic tube was removed at 2 months following normal cystography. Restoration of bowel continuity is planned.

Conclusion: While we await longer followup and experience in larger series, robotic rectovesical fistula appears feasible and represents an attractive alternative to open or laparoscopic approaches.