Improvement of endoscopically assisted neovagina: new application instruments and traction device

Abstract

Introduction: Despite the advantages of the laparoscopic-assisted technique of creation of a neovagina, the method is still time-consuming and has weak points. The main complications are the slipping off of the traction device, the ripping off of the threads, the unstable direction of the tension, and further technical complications. Technical and clinical results: Through the perfected mechanics of the traction device and the application instruments all the complications due to the old mechanical system can now be avoided. The first clinical results show that using the new modern equipment leads to a significant reduction of the operation time and of the time of tension but still having the same equally good functional and anatomical results without a higher complication rate. Conclusion: Through the new developed traction device and the perfected application instruments an operation set exists for the optimization of the laparoscopic-assisted creation of a neovagina and therefore for the therapy of a lot of cases of vaginal aplasia.

Laparoscopically Assisted Neovaginoplasty in Vaginal Agenesis: A Long-Term Outcome Study in 240 Patients

“…Our prospective and retrospective data were collected from the sizeable group of 240 patients diagnosed with MRKH or CAIS-related vaginal agenesis and treated using our previously described laparoscopically assisted neovaginoplasty technique 6,7,9,10 at our institution during 1998-2011. This technique is considerably less invasive than the standard laparoscopic Vecchietti procedure as it dispenses with dissection of the vesicorectal space, using instruments that received approval from the United States Food and Drug Administration in 2010.…”

“…1,5 Our Centre for Rare Female Genital Malformations developed and optimized a laparoscopically assisted technique that creates a neovagina in a standardized, controlled manner by vaginoabdominal blunt perforation and traction exerted by a device positioned on the abdomen. [6][7][8] We subsequently demonstrated in 101 patients that this technique produced better functional results with fewer complications than the standard laparoscopic Vecchietti procedure involving dissection of the vesicorectal space. 9 Based on the substantial body of prospective and retrospective data collected at our institution between 1998 and 2011, the present study was conducted to assess our neovaginoplasty technique with regard to intermediate and long-term outcome.…”

Neovagina creation in vaginal agenesis: development of a new laparoscopic Vecchietti-based procedure and optimized instruments in a prospective comparative interventional study in 101 patients

“…The third phase, therefore, aimed to improve the procedure further by using our newly developed set of instruments (20).…”

Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review

“…Surgical vesicorectal tunnelling is not required and the use of vaginoabdominal blunt perforation of the vaginal dimple is not associated with high complication rates or poor functional outcome. This low‐risk procedure creates a vaginal canal in the correct axis that provides an adequate size and secretory capacity for vaginal intercourse without the need for continual postoperative dilation, and therefore requires minimal care to maintain the long‐term benefits of the procedure …”