Repair of vesciovaginal fistula (VVF) represents a surgical challenge with regard to timing of repair, surgical approach, and postoperative patient management. Vesicovaginal fistula (VVF) repair may be undertaken via open, laparoscopic/robotic, or vaginal approaches (Leng et al., Urology 160:1995–1999, 1998). VVF below the trigone are usually repaired vaginally. Supratrigonal fistulas have been repaired utilizing open and laparoscopic/robotic approaches. This is typically accomplished through an intravesical approach. The extravesical approach to VVF repair has also been described for supratrigonal fistulas; this approach may improve the postoperative morbidity associated with a large cystotomy. The following chapter will discuss the operative setup, positioning, trocar configuration, instrumentation, step-by-step technique, common complications, and follow-up for robotic-assisted VVF repair.