Laparoscopic vaginal reconstruction using an ileal segment

Objective

To evaluate the feasibility of laparoscopic vaginal reconstruction using an ileal segment in patients with vaginal atresia, male-female transsexual patients, or patients who had vaginal cancer.

Methods

A retrospective review of the records of 80 patients who underwent laparoscopic vaginoplasty between 2004 and 2007 at Beijing Anzhen Hospital, China.

Results

Nineteen (23.8%) patients underwent total laparoscopic vaginoplasty and 61 (76.3%) underwent laparoscope-assisted vaginoplasty. There were 64 (80.0%) primary operations and 16 (20.0%) secondary operations. All of the surgeries were completed successfully and no intraoperative complications occurred. Mean follow-up time was 14 months. Postoperatively, 5 women had vaginal stenosis, while 4 women had no sexual partner during the follow-up period which meant that they could not be assessed completely. The remaining 71 patients were satisfied with their sexual lives after surgery.

Conclusion

Vaginal reconstruction performed via total laparoscopic vaginoplasty or a laparoscope-assisted technique using an ileal segment has a high success rate for a functional vagina and patient satisfaction.     

全腹腔镜下带血管蒂回肠移植阴道成形术18例临床分析

目的:总结腹腔镜下行带血管蒂回肠移植阴道成形术的方法及临床应用效果。方法:回顾性分析18例全部在腹腔镜下带作的血管蒂回肠移植阴道成形术患者的临床资料。结果:18例手术均获得成功,术后随访3个月至1年半,移植回肠段成活良好,再造阴道符合生理要求;有性生活者14例,均满意。术后不完全肠梗阻1例,经手术及对症处理治愈。结论:腹腔镜下回肠代阴道是目前较为理想的阴道成形方法,腹腔镜下回肠代阴道手术在腹壁上不留手术瘢痕,美容效果理想,但操作难度大,费用较高,可供医患选择。     

Construction of a neovagina for patients with a flat perineum

Vaginal dilatation affords an acceptable functional success rate for women with vaginal agenesis, provided there is an introitus with a pouch or dimple. In contrast, women with a flat perineum who lack labia majora, labia minora, and vaginal introitus have no alternative to development of a vagina-like orifice other than surgical vaginoplasty. This study addresses the anatomic and functional success rate of these women after undergoing modified McIndoe technique. Thirty-four patients with microphallus were assigned the female gender as the sex of rearing at the Johns Hopkins Hospital between 1951 and 1987. A majority of patients underwent surgical revision of the external genitalia and gonadectomy before 2 years of age. Family counseling was begun at birth. Of these patients, 15 (17 to 25 years old) who requested the ability to have sexual relations underwent modified McIndoe vaginoplasty. All 15 of these women have experienced satisfactory coitus. All but one patient have an adequate size vagina. Results of this group indicate that patients with ambiguous genitalia as a result of male hermaphroditism or microphallus can achieve functional success after vaginal creation with a modified McIndoe technique despite the presence of a flat perineum.     

Laparoscopic Sacrocolpopexy With a Mesh for Sigmoid Neovaginal Prolapse: A Case Report

BackgroundCreating a functional neovagina is a practical therapeutic intervention for women with congenital vaginal agenesis and sexual needs. Although the incidence of neovaginal prolapse (NP) is low, it is inconvenient for patients and is a challenging problem for gynecologists.CaseA 32-year-old woman who had undergone transabdominal sigmoid vaginoplasty 10 years previously at another hospital visited our clinic for evaluation and treatment of NP. Gynecological examination showed exstrophy of the vaginal apex, 4 cm beyond the hymen. Laparoscopic sacrocolpopexy was performed using a mesh. The mesh was sutured at the anterior wall and apex of the neovagina and suspended in the anterior sacral region without blood vessels.Summary and ConclusionLaparoscopic sacrocolpopexy might be an effective and safe treatment for NP.     

腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术治疗先天性无阴道临床疗效比较

目的探讨腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术的临床疗效。方法采用随机对照的研究方法 ,对2001年1月至2010年12月第三军医大学附属西南医院40例先天性无阴道患者按随机表法,1:2随机化分组,分别接受腹腔镜乙状结肠代阴道成形术(14例)和腹膜代阴道成形术(26例),比较2组的围手术期参数及术后疗效。结果 40例患者均在腹腔镜下成功完成手术,腹膜代阴道组较乙状结肠代阴道组手术时间短,术中出血量少,术后恢复快(P﹤0.05)。术后随访6～108个月,阴道平均深度、性生活启动时间和性功能指数量表评分比较,两组差异均无统计学意义(P﹥0.05)。结论腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术均是安全、疗效满意的手术方式,但腹腔镜腹膜代阴道成形术更微创、术后患者恢复更快。     

Anatomic and Functional Outcomes of Paramesonephric Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: Uncu Modification

Objective

To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification.

Laparoscopic cervical cerclage: a series in women with a history of second trimester miscarriage

We sought to develop a laparoscopic technique for placement of a cervical cerclage in women with a history of failed vaginal cerclage and recurrent miscarriage. This was a case series, design classification III. The study took place at The Recurrent Miscarriage Clinic at National Women's Hospital, Auckland, New Zealand. Ten women with a history of second trimester miscarriage after failed vaginal cerclage, and 1 woman with a history of second trimester miscarriage and findings of a clinically deficient cervix were studied. A laparoscopic cervical cerclage was placed before pregnancy. No intraoperative or postoperative complications were experienced. Ten of 11 women subsequently became pregnant and all delivered live babies by cesarean section in the third trimester. Laparoscopic cervical cerclage is feasible and effective. Outcomes are good in a particularly high-risk group of women with cervical incompetence, who have had failed vaginal cerclage and have a history of recurrent pregnancy loss.     

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome

ObjectiveTo evaluate anatomic and sexual outcomes in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome after laparoscopic Davydov (laparoscopic peritoneal vaginoplasty).DesignProspective follow-up study of patients with MRKH syndrome after vaginoplasty (Design classification: II-2).SettingAcademic hospital.PatientsPatients with MRKH syndrome and frequency-matched age-comparable healthy controls.InterventionThirty-one patients with MRKH syndrome underwent surgery with the procedure, and their clinical, surgical, and follow-up data were recorded. A Female Sexual Function Index (FSFI) questionnaire was administrated to evaluate sexual functions of patients who became sexually active and compared them with 50 randomly selected, age-matched healthy women.MeasurementsFSFI scores in women with MRKH syndrome and in control subjects. Clinical and anatomic measurements of neovagina.Main ResultsThe laparoscopic Davydov was successfully completed in all 31 cases, with 24 patients monitored. The mean length of the neovagina was 6.27±1.25 cm. There was no statistical difference in the total FSFI score between the case and control groups. There is indication that shorter neovaginal length, especially of<7 cm, appears to be associated with lower total FSFI scores.ConclusionLaparoscopic Davydov is a safe, effective treatment of Mayer-Rokitansky-Kuster-Hauser syndrome with minimal invasion and a relatively low complication rate.     

A fertility-preserving option in early cervical carcinoma: laparoscopy-assisted vaginal radical trachelectomy and pelvic lymphadenectomy

OBJECTIVE: Laparoscopic vaginal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy or chemoradiation in young women with stage IA2 to IB cervical cancers. The aim of this study is to describe the feasibility and outcome of laparoscopic radical vaginal trachelectomy and pelvic lymphadenectomy in women treated with early cervical cancers who wish to maintain fertility. STUDY DESIGN: From August 2000 through December 2004, 16 patients were offered this procedure. Patients were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. Laparoscopic pelvic lymphadenectomies were performed in all patients. Vaginal radical trachelectomy was performed immediately if removed lymph nodes were negative. Obstetrical and oncological outcomes were evaluated. RESULTS: Sixteen women underwent this procedure. The mean operative time was 142 min (115-178 min), with a mean blood loss of 180 ml (120-230 ml), and the average hospital stay was 6.7 days. No intraoperative or postoperative complications occurred. With an average follow-up of 28.2 months, there have been no recurrences. Five pregnancies have subsequently occurred, with two third-trimester deliveries, two miscarriages at 24 and 26 weeks' gestation, and one patient is currently 18 weeks' pregnant. CONCLUSIONS: Laparoscopy-assisted radical vaginal trachelectomy is an adequate treatment, with its minimally invasive procedure and shorter recovery time, for early-stage cervical cancer in women who wish to preserve fertility. However, fertility issues remain the largest unanswered problem with this technique.     

腹腔镜下子宫峡部环扎术

子宫峡部环扎术是治疗宫颈机能不全最主要的方法。对于反复经阴道环扎失败或宫颈解剖异常不能经阴道环扎的患者,可选择经腹腔镜子宫峡部环扎。腹腔镜子宫峡部环扎术可在非孕期或早孕期进行。孕中晚期发生胎儿异常需终止妊娠时可经剖腹或腹腔镜拆除缝线经后阴道分娩。足月妊娠则需要剖宫产终止妊娠。腹腔镜下子宫峡部环扎术是治疗宫颈机能不全的有效方法之一,但其是否能作为治疗宫颈机能不全的标准术式尚待多中心临床随机对照研究结果证实。     

Lethal Necrotizing Cellulitis Caused by ESBL-Producing E. Coli after Laparoscopic Intestinal Vaginoplasty

Background

The absence of a functional vagina has a negative effect on the quality of life of women. Multiple surgical procedures have been described for vaginal reconstruction in these patients.

先天性阴道畸形阴道成形术66例临床分析

目的:探讨阴道成形术患者的临床特点及术式选择。方法:回顾性分析66例先天性阴道畸形行阴道成形术患者的临床资料。结果:47例先天性无阴道患者中,8例伴周期性或不规则下腹痛(17.0%);19例阴道闭锁患者中16例伴下腹痛(84.2%)。乙状结肠法术后性生活满意率最高(75%),但手术时间和出血量均较多;改良的小阴唇皮瓣法术后外阴形态及创面恢复良好,性生活满意率高(66.7%)。结论:对合并下腹痛的先天性阴道畸形患者进行腹腔探查是十分必要的;对于小阴唇丰满者改良的小阴唇皮瓣法值得推广。     

Laparoscopic promontofixation for the treatment of recurrent sigmoid neovaginal prolapse: case report and systematic review of the literature

Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. A 34-year-old woman with vaginal agenesis underwent vaginoplasty using sigmoid colon. Almost 6 years after the initial operation, she started complaining of a bearing-down sensation and an increase in vaginal discharge. She underwent 2 open surgeries and one vaginal surgery to treat the prolapse with no success. She came to our service and at vaginal examination the neovagina protruded approximately 5 cm beyond the hymen. The prolapse was treated successfully using a laparoscopic approach to suspend the neovagina to the sacral promontory (laparoscopic promontofixation). Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Laparoscopy may be an alternative approach to restore the neovagina without compromising its function.     

New Laparoscopic Vaginoplasty Procedure With a Modified Peritoneal Pull-Down Technique in Four Patients With Mayer−Rokitansky−Küster−Hauser Syndrome

BackgroundVarious vaginal reconstructive procedures have been described for patients with Mayer?Rokitansky?Küster?Hauser (MRKH) syndrome. We describe the success of a novel laparoscopic vaginoplasty procedure using an anteroposterior peritoneal pull-down technique.CaseFour patients with MRKH syndrome underwent a modified laparoscopic Davydov procedure using an anteroposterior peritoneal pull-down technique with a transverse laparoscopic incision below the strand. Anatomical success was achieved in all patients, allowing easy introduction of 2 fingers, an epithelialized neovagina, and a mean length of 8.0 cm (range 7.0-9.0cm). All 3 patients who attempted sexual intercourse were successful, and neovagina size was adequately maintained at the long-term follow-up in the remaining patient.Summary and ConclusionThis novel procedure presents as a feasible and an effective approach for vaginal reconstruction in patients with MRKH syndrome.     

Laparoscopic Posthysterectomy Vaginal Vault Excision for Chronic Pelvic Pain and Deep Dyspareunia

Study ObjectiveTo evaluate the outcome of posthysterectomy laparoscopic vaginal vault excision and its long-term effects on chronic pelvic pain, dyspareunia, quality of life, and patient satisfaction.Materials and MethodsThis is a retrospective cohort study (Canadian task force classification II–3) incorporating case note review and a postal questionnaire. It describes 22 consecutive patients who underwent laparoscopic vaginal vault excision for posthysterectomy dyspareunia and chronic pelvic pain. At laparoscopy, full thickness vaginal vault was excised along with scar tissue or any cyst. The vaginal cuff was closed laparoscopically. The patients were sent a validated questionnaire to assess their pain scores, general health, quality of life, and satisfaction with the surgery. The mean interval from vaginal vault excision and to questionnaire distribution was 1.8 years. The statistical analysis was performed with SPSS 15.ResultsThe mean age of the women was 40 years. All women had vaginal vault tenderness on examination and underwent laparoscopic vaginal vault excision. The only intraoperative complication was 1 puncture injury of the bladder, which was produced by 10-Veres needle during manipulation. A single or a combination of additional procedures was performed at the same time. The patient satisfaction questionnaires were received from 16 (72.7%) women. Of the 16 (72.7%) respondents, 13 (81.25%) confirmed improvement in dyspareunia. The mean pain scores decreased, and quality of life and general health improved significantly after vaginal vault excision (p <.05, t test).ConclusionLaparoscopic vaginal apex excision is a safe and effective management option after carefully excluding other causes of deep dyspareunia and chronic pelvic pain. It also provides an opportunity to detect and surgically excise previously undiagnosed endometriosis and other disease.     

Laparoscopic Burch colposuspension for recurrent stress urinary incontinence

STUDY OBJECTIVE: To evaluate the effectiveness of laparoscopic Burch colposuspension in the treatment of recurrent stress urinary incontinence in women with previous vaginal or abdominal retropubic continence surgery. DESIGN: Retrospective analysis over 36 months (Canadian Task Force classification III). SETTING: Community hospital. PATIENTS: Thirty-three consecutive patients. INTERVENTION: Laparoscopic Burch colposuspension. MEASUREMENTS AND MAIN RESULTS: Data were obtained by retrospective chart review, telephone interviews, and follow-up physical examinations. Of the 33 patients, 17 (52%) had undergone open retropubic procedures (Burch or Marshall-Marchetti-Krantz), 11 (33%) had had vaginal retropubic needle suspension, and 5 (15%) pubovaginal sling operation. Additional laparoscopic and/or vaginal reconstructive surgery was completed in 32 women (97%) at time of laparoscopic Burch. Average overall operating time was 165 minutes (range 60-287 min), mean estimated blood loss was 178 ml (range 50-600 ml), and hospital stay was 1.1 days. Three intraoperative complications occurred, two cystotomies and one serosal bowel injury. Postoperative objective evaluation over average follow-up of 18.6 months revealed a 90% stress urinary incontinence cure rate. CONCLUSION: Laparoscopic Burch colposuspension is safe and effective treatment of recurrent stress urinary incontinence in women who have undergone previous procedures for retropubic continence.     

Laparoscopic myomectomy and pregnancy outcome in infertile patients

OBJECTIVE: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. DESIGN: Retrospective analysis. SETTING: Tertiary care advanced laparoscopic center. PATIENT(S): Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter. INTERVENTION(S): Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy, delivery rate, and pregnancy-related complications. RESULT(S): The average size of the myomas removed was 6 cm (range, 4-13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n = 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. CONCLUSION(S): Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome.     

Pregnancy outcomes and deliveries after laparoscopic myomectomy

STUDY OBJECTIVE: To assess pregnancy outcomes and deliveries after laparoscopic myomectomy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: General hospital. PATIENTS: Three hundred fifty-nine women. INTERVENTIONS: Laparoscopic myomectomy and laparoscopic and/or hysteroscopic treatment of associated pathologies. MEASUREMENTS AND MAIN RESULTS: Five patients (1.39%) were lost to follow-up. Seventy-two women were pregnant at least once after laparoscopic myomectomy, for a total of 76 pregnancies. Four women conceived twice and four are pregnant as of this writing. One multiple pregnancy occurred. Twelve pregnancies resulted in first-trimester miscarriage, one in an ectopic pregnancy, one in a blighted ovum, and one in a hydatiform mole. One patient underwent elective first-trimester termination of pregnancy. Thirty-one women had vaginal delivery at term and 26 were delivered by cesarean section. No case of uterine rupture or dehiscence occurred. CONCLUSION: Our technique of laparoscopic myomectomy appears to allow safe vaginal delivery.     

腹腔镜腹膜阴道成形术43例临床应用探讨

目的:探讨腹腔镜腹膜阴道成形术治疗先天性无阴道的应用价值。方法:回顾分析2007年6月～2009年6月我院为43例先天性阴道缺如患者行腹腔镜腹膜阴道成形术的临床资料。结果:43例腹膜阴道成形术均用腹腔镜完成,手术时间50～150min,平均60min,术中出血量40～100ml,平均60ml;术后住院15～24天,平均19天;术后随访1～22个月,平均11.5个月;38例腹膜阴道成形术阴道深9cm,4例阴道深7cm,1例阴道深6cm;成形阴道,外阴形态良好,阴道壁光滑、柔软湿润,弹性良好,无牵拉不适感;手术均无严重并发症发生;已婚或有性生活40例,39例性生活满意。结论:腹腔镜腹膜阴道成形术具有术式微创、操作简单的优势,外阴保持完整,术后无须使用模具,阴道外观与功能接近正常女性,是治疗先天性无阴道患者理想术式之一。