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.
OBJECTIVE
To improve the laparoscopic Vecchietti procedure and optimize instrumentation for treatment of congenital vaginal agenesis with a minimum of complications and optimal functional outcome, in comparison with the conventional laparoscopic Vecchietti procedure.


METHODS
Prospective comparative interventional study.


METHODS
University hospital.


METHODS
One hundred one patients with congenital vaginal agenesis.


METHODS
The interventions compared were [1] a new laparoscopic, Vecchietti-based method using vaginoabdominal blunt perforation without vesicorectal tunneling and [2] the laparoscopic Vecchietti procedure.


METHODS
Duration of surgery and traction, functional results, surgical and technical complications.


RESULTS
Without tunneling and with new instruments, mean operative time was more than halved, from 113.0 to 47.5 minutes, with a significantly reduced complication rate for bladder lesions and no bowel lesions. Mean traction time was similarly reduced, from 11.7 to 4.8 days. No instrument-related complications were seen with our new instrument set. After 6 months, the longer neovagina of 10.6 cm that was achieved with the new method was still 2.5 cm longer than the conventional result. No patients needed lubricants or had sustained pain during intercourse.


CONCLUSIONS
Our new method for neovagina creation resulted in shorter operation and traction times, better functional results, and fewer surgical complications and no technical ones. It is therefore a safer, shorter, more effective, and less traumatic procedure.
Brucker
Sara Y
SY
Department of Obstetrics and Gynaecology, Tübingen University Hospital, Tübingen, Germany.
Gegusch
Michaela
M
Zubke
Wolfgang
W
Rall
Katharina
K
Gauwerky
Johannes F
JF
Wallwiener
Diethelm
D
D000293:Adolescent; D000328:Adult; D003075:Coitus; D004867:Equipment Design; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects; D011446:Prospective Studies; D020127:Recovery of Function; D019738:Surgically-Created Structures / Q000009:adverse effects; D013997:Time Factors; D014143:Traction; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult