Genitourinary fistulas involve abnormal connections between the urinary or genital tract and surrounding structures. Surgical repair is often required to restore normal function and improve the patient's quality of life. In recent years, robotic-assisted surgery has gained popularity due to its potential advantages, such as improved visualization, precise instrumentation, and shorter recovery times. This study aimed to compare the outcomes of robotic-assisted genitourinary fistula repair with traditional open surgery.

A retrospective analysis was conducted using medical records of patients who underwent genitourinary fistula repair over a 10-year period. Patients were divided into two groups: the robotic group ( N=26) (patients who underwent robotic-assisted repair) and the open group(N=24) (patients who underwent open surgical repair). Surgical success rates, defined as the absence of fistula recurrence, along with postoperative complications, length of hospital stay, and patient-reported outcomes were compared between the two groups.

A total of 50 patients were included in the study, with ( N=26) in the robotic group and (N=24) of patients in the open group. The surgical success rate was 96.15% in the robotic group [1 recurrence out of 26] and 95.83% [1 recurrence out of 24] in the open group. Although the success rate was higher in the robotic group, this difference was not statistically significant (p > 0.05). The blood loss was higher in the robotic group compared to the open approach and statistically significant (p=0.024) In addition to the repair a flap repair was done in 17 of the 26 robotic cases and 3 of the 24 cases in the open group ( p=< 0.001)The median length of hospital stay was 8 days in the robotic group and 6 days in the open group, w favoring the open approach (p < 0.041).

This retrospective study suggests that both robotic-assisted and open surgical approaches are viable options for genitourinary fistula repair, with comparable surgical success rates and postoperative complications. The robotic approach had a longer hospital stay, potentially due to the early learning curve. However, the decision to choose one approach over the other should be individualized, considering factors such as surgeon expertise, patient preferences, and available resources.