2 Diagnostic and Therapeutic Endoscopy Figure 1: Transvesicoscpic vision of VVF. Figure 3: Closure of vagina vertically. Figure 2: Circumﬁstula dissection being made. Figure 4: Bladder closure completed. 2.1. Surgical Technique. The patient was placed in modiﬁed lithotomy position. An initial cystoscopy was performed using insuﬄation of gas and the ﬁstula inspected in detail (Figure 1). The bladder was ﬁxed to the anterior abdominal wall under cystoscopic guidance. The bladder was ﬁxed using 1/0 prolene and placed by using a technique of looping the suture material into the bladder with the help of a spinal needle and then hooking it with the same suture through a neighbouring site. A 5 mm endoscopic port was placed into the blad- der under cystoscopic guidance in the midline, halfway between the umbilicus and pubic symphysis. Two more working/instrument ports were placed 5 cm laterally and inferior to the endoscopic port on either side. Once the ports were in place the cystoscope was withdrawn and the urethra catheterised. The vagina was packed with betadine packs so as to prevent gas leak. The ﬁstula was once again inspected. A circum ﬁstula incision was made and the bladder dissected away from the underlying vagina (Figure 2). The edges of the ﬁstula were excised. Once adequate dissection was achieved, the vagina was sutured vertically (Figure 3) and the bladder edges sutured horizontally (Figure 4). The bladder was closed using 4/0 vicryl. The two ureteric oriﬁces were catheterised using 5F infant feeding tubes and brought outside the bladder for drainage. The bladder was also catheterised. The infant feeding tubes were removed after one week and the catheter removed after two weeks. All patients underwent three-swab test, on table cys- tograms and cystoscopy in the follow-up period. All patients were reassessed six months after surgery. They all were requested to answer a questionnaire related to their act of micturition, satisfaction with the outcome of their surgery, and sexual performance. 3. Results Four patients with history of VVF following gynaecologic surgical procedure presented to us for repair during the period Jan. 2008–Jan. 2009. Their ages ranged from 42 years to 58 years. All the four had undergone total abdominal hysterectomy. All the ﬁstulas were located superior to the trigone, away from the ureteric oriﬁces. The size of the ﬁstulas ranged from 1 cm to 2 cm. None of these patients had undergone previous repairs. Transvesicoscopic laparoscopy was performed in all the three patients under general anaesthesia and in modiﬁed lithotomy position. Operative time ranged from 175 minutes to 235 minutes. The ﬁrst case was the one with the maximum time