Laparoscopic vaginoplasty using a sigmoid graft through the umbilical single-incision hybrid transperineal approach: our initial experience.
BACKGROUND
For better cosmetic appearance, attempts to reduce the number of laparoscopic wounds have been sought. Investigators have thus begun to carry out procedures through a single incision or natural orifice endoscopic surgery instead of using conventional laparoscopic surgery. The authors here describe transumbilical single-incision hybrid transperineal laparoscopic surgery as a novel approach for vaginoplasty using a sigmoid graft.


METHODS
From August 2010 to October 2012, 15 young females with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome underwent laparoscopic sigmoid vaginosplasty using a combined transumbilical single-incision and transperineal approach. A multichannel single port was placed through the umbilical incision for the main laparoscopic procedures. A 12-mm trocar as an assisting working port was inserted into the pelvic cavity through the transvaginal dimple between the rectum and urethra.


RESULTS
A functioning vagina 12-15 cm in length and approximately 4 cm in width was created in all the patients. The average operative time and hospital stay were 151.5±34.2 minutes and 7.4±3.2 days, respectively. The only perioperative complications were 1 case of stress ulcer and 1 case with umbilical infection. All patients were satisfied with the surgery, and 12 of them had subsequent sexual activity.


CONCLUSIONS
Transumbilical single-incision hybrid transperineal laparoscopic sigmoid vaginoplasty offers a feasible scarless approach for females with MRKH syndrome. The favorable cosmetic results would favor use of this type of vaginoplasty as an alternative to the conventional laparoscopic approach.
Department of Pediatric Surgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
Suolin
S
Li
Chi
C
Sun
Bin
B
Shi
Meng
M
Li
Lin
L
Liu
D058489:46, XX Disorders of Sex Development / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D003075:Coitus; D012809:Colon, Sigmoid / Q000637:transplantation*; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D003286:Contracture / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000601:surgery; D061646:Operative Time; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery*; D055815:Young Adult