Creation of a Neovagina by Laparoscopic Modified Vecchietti Technique: Anatomic and Functional Results

Abstract

Keywords► laparoscopy ► gynecologic surgery ► minimally invasive surgery ► mayer-rokitanskyküster-hauser syndrome ► androgen insensitivity syndrome ► sexuality AbstractPurpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods Retrospective study of nine patients with congenital vaginal aplasia submitted to the laparoscopic Vecchietti procedure, in our department, between 2006 and 2013. The anatomical results were evaluated by assessing the length, width and epithelialization of the neovagina at the postoperative visits. The functional outcome was evaluated using the Rosen Female Sexual Function Index (FSFI) questionnaire and comparing the patients' results to those of a control group of 20 healthy women. The statistical analysis was performed using SPSS Statistics version 19.0 (IBM, Armonk, NY, USA), Student t-test, Mann-Whitney U test and Fisher exact test. Results The condition underlying the vaginal aplasia was Mayer-Rokitansky-Küster-Hauser syndrome in eight cases, and androgen insensitivity syndrome in one case. The average preoperative vaginal length was 2.9 cm. At surgery, the mean age of the patients was 22.2 years. The surgery was performed successfully in all patients and no intra or postoperative complications were recorded. At the first postoperative visit (6 to 8 weeks after surgery), the mean vaginal length was 8.1 cm. In all cases, the neovagina was epithelialized and had an appropriate width. The mean FSFI total and single domain scores did not differ significantly from those of the control group: 27.5 vs. 30.6 (total); 4.0 vs. 4.2 (desire); 4.4 vs. 5.2 (arousal); 5.2 vs. 5.3 (lubrication); 4.2 vs. 5.0 (orgasm); 5.3 vs. 5.5 (satisfaction) and 4.4 vs. 5.4 (comfort). Conclusions This modified laparoscopic Vecchietti technique is a simple, safe and effective procedure, which allows patients with congenital vaginal aplasia to have a satisfactory sexual activity, comparable to that of normal controls.

Vaginal Reconstruction in Patients with Mayer–Rokitansky–Küster–Hauser Syndrome—One Centre Experience

“…The stent had a 4.5 cm diameter and a length of 13 cm. Seccia et al (2002) presented their technique, where the removal of the mould was performed after 7 days [ 25 ]. Before the daily replacement of the vaginal stent, cream with free protein extract of calf blood was used.…”

Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence

“…In fact, as above, several publications had already stood the benefits and safety of the laparoscopic-modified Vecchietti procedure; [24][25][26][27][28][29] however, we are the first to publish the results of a mini-laparoscopic approach.…”

“…23 The use of a minimally invasive technique with concomitant vaginal and laparoscopic approachesthe modified laparoscopic Vecchietti procedurewas an important advance in this setting, resulting in shorter operative times with minor associated complications, being presently recognized as a safe, simple, and effective procedure. [24][25][26][27][28][29] Mini-laparoscopy, with 5-mm optics and 3-mm trocars, is a recent and growing surgical option in gynecology with recent studies reporting its utility and feasibility in a variety of gynecological procedures with several validated benefits. [30][31][32][33][34] Additionally, indocyanine green (ICG) is a fluorescent dye with a well-documented safety profile that is particularly useful for fluorescence-guided surgery because its excitation peak and emission peak are in near infrared (NIR).…”

“…23 The use of a minimally invasive technique with concomitant vaginal and laparoscopic approaches — the modified laparoscopic Vecchietti procedure — was an important advance in this setting, resulting in shorter operative times with minor associated complications, being presently recognized as a safe, simple, and effective procedure. 24-29…”

The role of laparoscopy in paediatric and adolescent gynaecology

“…Many authors emphasise that the modified Vecchietti laparoscopic technique is a simple, fast, effective, and low-risk procedure that allows the creation of a neovagina in the right axis, of appropriate size, and retaining excretion capacity. It allows women with congenital vaginal aplasia to start normal sexual activity with proper effect (Table I) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”