PMC6026928_01
Cystoscopic appearance of small vesicovaginal fistula (arrows).
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The VVF was identified with a cystoscope using insufflation of gas and it was verified by a guidewire (Fig. 1).
Port placement for transvesicoscopic sealing of fistula tract.
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The second 5-mm port was placed into the bladder laterally at the midline and inferior to the first port (Fig. 2).
Sealing the fistula tract with the bipolar sealer.
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The fistula tract was grasped and sealed by an EBVS (LigaSure  5 mm blunt tip 37 cm sealer; Medtronic, Inc., Dublin, Ireland) (Fig. 3).
Postoperative cystoscopic appearance of the sealed vesicovaginal fistula.
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The patient was instructed to return to our office 3 weeks after surgery for urethral Foley catheter removal and subsequent cystoscopic and vaginal inspection to confirm VVF repair (Fig. 4).