Outcomes in patients undergoing robotic reconstructive uterovaginal anastomosis of congenital cervical and vaginal atresia

Liu

Intl J Gynecology & Obste

et al. 2020

Self Cite

Objective To evaluate the feasibility of laparoscopic metroplasty for the treatment of unicornuate uterus with a functional noncommunicating rudimentary horn. Methods Laparoscopic metroplasty was performed in one patient using traditional laparoscopy and four patients using robot‐assisted laparoscopy from December 2013 to December 2017 at the Obstetrics and Gynecology Hospital of Fudan University. The records of the five patients were analyzed retrospectively. Results In all five patients the unicornuate uterus and functional noncommunicating rudimentary horn were unified into a single cavity without intraoperative or postoperative complications. Average operative time was 281 minutes (range, 204–330 minutes) and average blood loss was 180 mL (range, 100–300 mL). Postoperative hospital stay was 7 days (range, 5–11 days) and there was no re‐admission. All patients were relieved of pain and had regular menstruation after surgery. Average follow‐up time was 44 months (range, 22–70 months). One patient conceived by in vitro fertilization and embryo transfer 2 years after the operation and delivered twins by cesarean at 33 weeks. Conclusion Laparoscopic metroplasty, with or without robotic assistance, is an acceptable alternative to resection for a noncommunicating rudimentary horn with a functional endometrium.

Section: Methodsmentioning

confidence: 99%

Laparoscopic metroplasty for unicornuate uterus with a functional noncommunicating rudimentary horn

Liu

Intl J Gynecology & Obste

et al. 2020

Self Cite

“…8 Robot-assisted surgeries have also been reported. 9 In the present case, we combined laparoscopic surgery with vaginal surgery. The surgery was performed laparoscopically because it allowed us to observe the inside of the abdominal cavity and later harvest the free peritoneum.…”

Section: Discussionmentioning

confidence: 97%

“…Others have reported inserting a Foley's catheter from the uterus to the vagina to prevent natural closing of the hollowed-out cervical area, obtaining good results with no restenosis. 9 In the present study, we used an H/S Elliptosphere catheter used in hysterosalpingography, which was passed from the vagina though the cervical canal to the uterine cavity. In addition, we promoted epithelization of the cervical canal mucosa by wrapping the autologous peritoneum collected laparoscopically around the catheter and fixing it in the uterine cervix.…”

Section: Discussionmentioning

confidence: 99%

Novel Method of Cervicoplasty Using Autologous Peritoneum for Cervicovaginal Atresia

Fujino

Ikemoto

Kitade

et al. 2020

Surg J

Cervicovaginal atresia with a functional uterus is rare. There are no established surgical methods to treat this condition, and only a few reports have been published on surgical techniques. Furthermore, postoperative complications, such as restenosis, often require reoperation. A 19-year-old woman was pointed out cervical hypoplasia and referred to our hospital for further examination and treatment. A pelvic examination revealed that the vagina had a slight recession with a blind end. Transrectal ultrasound and pelvic magnetic resonance imaging revealed congenital vaginal agenesis and cervical hypoplasia. Elective surgery was performed after reshaping the vagina. A radical surgery was performed 10 months later after sufficient self-dilation by using Frank's technique in an outpatient setting. At first, we approached by laparoscopically to correct autologous peritoneum and to bladder detach, then the cervical canal was identified. Next, a skin biopsy punch was used several times to hollow out the cervical tissue to shape and expand the cervical canal. A catheter was then placed in the uterus and autologous peritoneum was wrapped around it and fixed to the cervical canal. The catheter was removed 6 weeks postoperatively, and the patient continued dilating her vagina until she was able to have sexual intercourse, and then stopped the self-dilation. Eight months postoperatively, the patient did not report any menstrual irregularities. It is important to make corrections to prevent restenosis of the vagina and cervical canal and prevent the symptoms from recurring. Make use of autologous peritoneum as graft onto the cervical canal is effective method for the treatment of cervicovaginal atresia.

“…Four cases of uterovaginal anastomosis and a cervical-vaginal reconstruction with small intestinal mucosa, all with surgical success, have been reported. 14,15 Clinical treatment can be an option if the patient does not manifest a current wish to get pregnant. It is based on the use of long-term medications that block menstruation.…”

Section: Discussionmentioning

confidence: 99%

“…17 There are five reports of pregnancy with fresh or frozen embryo transfers using this technique in patients with cervical agenesis, of which three have reached the end of gestation and two evolved to abortion. 14,[18][19][20] Transfer of embryos or gametes to the fallopian tube (ZIFT and GIFT) are optional techniques in cervical agenesis cases, but both require surgery, therefore increasing the risk of complications. However, a successful ZIFT case has been reported.…”

Section: Discussionmentioning

confidence: 99%

Uterine cervix and proximal third of vagina agenesis with functional uterus: Case report and literature review

Siqueira¹,

Hentschke²,

Wagner³

et al. 2019

Hum. Reprod. Arch.

objectives: We aimed to describe the case of a patient presenting cervix agenesis with presence of vagina and functioning uterus. Methods: A 19-year-old patient was referred to Human Reproduction service due to primary amenorrhea, cyclic pelvic pain, and dyspareunia. She was diagnosed with cervical and vaginal agenesis, and menstrual flow suppression was the chosen treatment. Results: Regarding treatment options, hysterectomy is the classic treatment; however, due to advances in minimally invasive surgery and reproductive medicine, procedures such as uterine-vaginal anastomosis have been proposed. Young patients with no current reproductive wish, may opt for hormonal suppression of the menstrual flow to minimize cyclical discomfort and prevent or treat possible foci of endometriosis. However, for those seeking pregnancy, techniques of assisted reproduction can be considered. The approach should always be individualized, considering the anatomical details, clinical aspects, and patient's opinion. Conclusions: Management of cervical agenesis is a challenge due to the complexity of the malformation and the difficulty in restoring and preserving fertility. Lastly, report such rare conditions and its treatment options, seems to be beneficial to help other patients with similar conditions.