Introduction: Hartmann procedure is the resection of the rectosigmoid colon, closure of the rectal stump, and creation of an end colostomy. Unfortunately, a Hartmann reversal to re-establish intestinal continuity carries high morbidity with a complication rate of up to 58%. Urological complications during Hartmann’s reversal procedure are rare however low rates of bladder injury (8.16-16%) and fistula formation (0.6-4.08%) have been reported in the literature. This video presents a step-by-step robotic surgical technique for the repair of two entero-vesical fistulae likely caused due to the incorrect use of the circular surgical stapler during a Hartmann’s reversal. Methods: Two consecutive cases of entero-vesical fistulae were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were evaluated and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages. Results: Two cases are reported with a median age of 71 (59-83). Both surgeries were uneventful with no intraoperative complications reported. Median operative time estimated blood loss, and length of stay were 557 (454-660) minutes, 150 (100-200) cc, and 3 (2-4) days, respectively. Median Jackson-Pratt drain removal time was 6.5 (4-9) days. Median catheter removal time was 18 (14-22) days. One case of urinary tract infection occurred during the postoperative period, which was successfully treated. No fistula recurrence was reported. Conclusions: Hartmann reversal is a morbid procedure that carries a small risk of urological complications, which may have a significant impact on patient's quality of life. Herein, we present the robotic-assisted management of enterovesical fistula formation following two Hartmann reversals and demonstrate the feasibility and safety of utilizing a minimally invasive approach. SOURCE OF Funding: None.
