Neovagina creation - laparoscopic Vecchetti-based approach with the new kit (original) (raw)
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Journal of Minimally Invasive Gynecology, 2020
Study Objective: To report a new improved laparoscopic Vecchietti vaginoplasty in patients with congenital vaginal agenesis and to investigate its efficacy and safety. Design: A retrospective descriptive and case-control study. Setting: Single academic institution. Patients: Women who were diagnosed with Mayer-Rokitansky-K€ uster-Hauster (MRKH) syndrome and underwent our new improved laparoscopic Vecchietti procedure from July 2010 to June 2019 were selected as the study group. The eligible participants had congenital vaginal agenesis with normal 46,XX karyotype and ovarian function. Age-matched, nulliparous, sexually active women were selected as the control group. Interventions: Women with MRKH syndrome in the study group underwent the novel improved laparoscopic Vecchietti procedure. All participants in both groups were required to complete Female Sexual Function Index and Female Genital Self-Image Scale questionnaires. Measurements and Main Results: The effects of our procedure, including the anatomic and functional efficacy of the neovagina, were the primary outcomes. The secondary outcomes consisted of the perioperative complications, surgical morbidities, and long-term postoperative discomfort. A total of 79 patients with MRKH syndrome underwent our new improved Vecchietti vaginoplasty, of whom 44 (55.7%) were diagnosed as Type I MRKH syndrome, whereas 35 (44.3%) were Type II MRKH syndrome. At a 30-month follow-up after surgery, an anatomic neovagina measuring 10.44 cm in length and 1.30 cm in width was achieved. All 79 patients obtained anatomic success with 92.41% of functional efficacy. Compared with 81 age-matched, nulliparous women in the control group, there was no statistical difference regardless of individual measure or total Female Sexual Function Index scores (p >.05). The Female Genital Self-Image Scale assessment showed a significantly lower score in patients undergoing the vaginoplasty (20.14 § 3.05 vs 22.95 § 2.12; p <.001). There were no severe perioperative complications except 1 mild bladder injury and 1 transient fever. Conclusion: Our novel improved laparoscopic Vecchietti vaginoplasty is a relatively safe and effective method for surgical treatment of congenital vaginal agenesis. It may be an alternative to neovagina creation for reaching satisfying anatomic and functional efficacy and improving patients' sexual function.
Fertility and Sterility, 2010
Objective: To present and evaluate the results of the Creatsas modification of Williams vaginoplasty for the creation of a neovagina in young women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: Retrospective study. Setting: Patient(s): Two hundred patients with the MRKH syndrome. Intervention(s): Clinical examination, pelvic ultrasound, intravenous urography and/or renal ultrasound, laparoscopy, karyotyping, orthopedics and ears, nose, and throat examination, magnetic resonance imaging, and Creatsas modification of Williams vaginoplasty. Main Outcome Measure(s): Neovaginal functional dimentions, neovaginal axis deviation, and quality of sexual life. Result(s): A functioning vagina of 10-12 cm in depth and 5 cm in width was created in 191 cases (95.5%). A vagina between 7 and 9 cm in depth and 2 and 3 cm in width was created for the remaining nine patients (4.5%). In addition, 94.5% declared themselves to have a satisfactory quality of sexual life, while only 5% of the cases reported an adequate one. Conclusion(s): Creatsas modification of Williams vaginoplasty is a simple, quick, and effective method for the treatment of vaginal agenesis. (Fertil Steril Ò 2010;94:1848-52.
Medicina
Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patient...
Possibility of Generation of An Efficacious Neovagina in Cases of Mayer Rokitansky–Kuster–Hauser syndrome with Satisfactory Vaginal Length, and Sexual Working of the Neovagina with an Innovative Technique-A Short Communication, 2024
Earlier we have extensively detailed Mayer Rokitansky-Kuster-Hauser Syndrome as well as procedures meant for generation of neovagina inclusive of utilization of graduated dilators of the non-surgical methodologies in the generation of neovagina dilators. Here our presentation is the manipulation of other surgical methodologies detailed is the innovative dissection of the neovagina utilizing bilateral 12 x5 cm fasciocutaneous skin flaps from the labiocrural folds implicating substantially greater dissection in contrast to other tissue grafts as well as there was prolongation of surgical time period in addition to stay in the postoperative period. Nevertheless, the plausible benefits of such tissue graft regions (for instance sufficient vaginal length, width leading to sexual working of the neovagina) might finally provide greater working postoperative results in contrast to other tissue grafts utilized with greater frequency. Need for the objective determination of nerves as well as sexual working is there in reference to theoretical estimation of such surgical methodology leads to greater advantages prior to the broader utilization of the tissue grafts by multidisciplinary teams gets put in to action.
BMC Urology, 2017
Background: Although vaginal agenesis as may occur in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition, it is associated with not only anatomical problems but also serious psychological and social problems like painful sexual intercourse, primary amenorrhea and infertility. Surgery, which is aimed at reconstruction of a vagina of adequate length and width to serve the function, is the main method of treatment. Many methods for vaginal reconstruction have been described but each has its complications and limitations. The most commonly preferred procedure for treating this condition is the McIndoe vaginoplasty which involves dissection into the recto-vesical space, inserting two split thickness skin grafts folded over a mold in this newly created space and regular dilatation of the neovagina postoperatively to avoid stenosis. However surgeons with this expertise in this part of the world are rare to find and where they are available, the special molds on which to fold the skin grafts into the neovaginal space are not readily available. Case presentation: A 21-year-old female with vaginal agenesis was operated on using a modification of the McIndoe procedure using a cylinder of a 60cm 3 syringe as a vaginal mold/form and kept in place. We left a Foley in place for 10 days and we did a dye test after removing the syringe to ensure that there was no leakage resulting from fistula formation. Conclusion: The operation was successful and on subsequent monthly reviews of the patient, she has a patent functional vagina of about 9 cm in length at 8 months after the operation with resumption of sexual intercourse.
Fertility and Sterility, 2005
Objective: To introduce a simple and quick surgical alternative for creating a neovagina in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome that offers good anatomic and functional results. Design: Historical report. Setting: Tertiary center for gynecologic endocrinology. Patient(s): Three patients with MRKH syndrome. Intervention(s): The creation of a neovagina according to Wharton-Sheares-George in patients with MRKH syndrome. Main Outcome Measure(s): Axis, length, and width of neovagina. Result(s): The George modification of the Wharton-Sheares neovaginoplasty was successfully performed in three patients. The results were excellent (normal axis and adequate length and width of neovagina), and there were no major complications. Conclusion(s): The George modification of the Sheares technique represents a simple, safe, and effective surgical option for creating a neovagina. The procedure is not highly complex and is therefore easy to learn and perform; no special surgical equipment is needed. Anatomic and functional results are very satisfying. Short-term hospitalization, accelerated recovery, and a rapid return to everyday life are important benefits for these young patients. These benefits also result in lower surgery-related expenses and therefore reduce the strain on the hospital's budget compared with other therapeutic options. The creation of a neovagina according to Wharton-Sheares-George might provide a satisfactory alternative for the surgical management of vaginal aplasia in patients with MRKH syndrome.
Laparoscopic Creation of Neovagina
Journal of Urology and Renal Diseases, 2018
Background: MRKH syndrome is also defined as müllerian agenesis. There are several surgical as well as nonsurgical methods for the treatment of vaginal agenesis still there is not any standardized treatment established. The laparoscopic procedure is a simple surgical technique with good cosmetic outcome. Aims and objective: The objective of the study was to perform laparoscopic creation of neo-vagina and analyze the outcome for the same with slightly modification of method with available instruments which leads to reduction in overall cost. Materials and methods: A total of 8 patients with vaginal agenesis were enrolled and all were treated with laparoscopic procedure. Results: Patient were treated successfully with laparoscopic procedure with satisfactory sexual life however patient were also facing slight pain manageable by oral analgesics, patients were having dyspareunia & coital difficulty also. Laparoscopic procedure decreases operative time as well as post-operative hospitalization. No significant additional equipment required at hospital during surgical procedure. Conclusion: Laparoscopic creation of neovagina appears to be safe, simple and effective method.
Total Endoscopic Vaginal Reconstruction in a Case of Mayer-Rokitansky-Kuster-Hauser Syndrome
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2005
The congenital absence of the vagina is an uncommonly encountered malformation, known as Rokitanski-Kuster-Hauser syndrome. These patients may enjoy an improved quality of sexual life once a neovagina is constructed. Surgical and nonsurgical (Frank's autodilatation) methods of creating a neovagina by recurrent dilatations require long and often embarrassing self-catheterization which is often painful, and yield a vagina with limited length. The developing ability to perform complicated surgery by laparoscopy has revived interest in colonic and ileal interposition procedures for formation of a neovagina. We report a case of sigmoid colpoplasty for neovagina creation in a 15-year-old girl, performed completely by laparoscopy, with a favorable outcome and an easier recovery.
American Journal of Obstetrics and Gynecology, 1994
A neovagina was created by a laparoscopic modification of Vecchietti's operation in two women with Mayer-Rokitansky-Kuster-Hauser syndrome. A plastic olive was applied to the vaginal dimple and pulled upward by two threads passed through the potential neovaginal space at laparoscopy, without the need for laparotomy or dissection of the vesicorectal space. In both cases we obtained very good results in anatomic and sexual functional terms.
Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap
Acta Médica Portuguesa, 2023
C i e n t í f i c a d a O r d e m d o s M é d i c o s ARTIGO ACEITE PARA PUBLICAÇÃO DISPONÍVEL EM WWW.ACTAMEDICAPORTUGUESA.COM ARTIGO ORIGINAL RESUMO Introdução: O tratamento cirúrgico de doentes com malformações do trato genital feminino é um problema complexo. Existem diferentes técnicas descritas na literatura cujo objetivo é a reconstrução de uma neovagina anatomicamente semelhante a uma vagina, com comprimento adequado para facilitar o funcionamento sexual e o menor risco de complicações possíveis. O objetivo deste estudo é descrever a técnica cirúrgica para reconstrução de uma neovagina a partir de um segmento ileal sem pedículo vascular. Material e Métodos: Apresentamos uma técnica cirúrgica desenvolvida num centro universitário terciário numa doente com síndrome de Mayer-Rokitansky-Küster-Hauser. Resultados: A cirurgia de vaginoplastia com segmento ileal foi realizada em três etapas. Na primeira etapa de intervenção foi realizada uma histerectomia laparoscópica com salpingectomia bilateral. A segunda etapa consistiu no isolamento do segmento ileal, anastomose ileal e preparação do segmento ileal. De seguida, o segmento ileal isolado foi reposicionado num molde de vagina para configurar a neovagina. Finalmente, a terceira etapa incluiu a adaptação do molde vaginal com a mucosa ileal ao espaço vesico-rectal. Conclusão: A vaginoplastia com segmento ileal sem pedículo vascular é uma opção que pode ser utilizada para reconstrução da vagina, pois proporciona um excelente tecido para reposição vaginal. Esta técnica pode ser utilizada em doentes com malformações do trato genital com ausência ou hipoplasia da vagina.