W Urbanowicz1, J Starzyk, J Sulislawski. 1. Department of Pediatric Urology, Polish-American Children's Hospital, Collegium Medicum, Jagiellonian University, Cracow, Poland.
Abstract
PURPOSE: Sigmoid vaginoplasty is an alternative technique for vaginal replacement. We describe the successful use of laparoscopy for reconstruction of a vagina in patients with the Mayer-Rokitansky-Kuster-Hauser syndrome. MATERIALS AND METHODS: Laparoscopic surgery was performed in 5 girls with a mean age of 17 years and 5 months. We used 4 ports, the first of which was inserted supraumbilically by the Hasson technique. The next 10 mm port was introduced through the right lower quadrant under visual control. Then 5 and 15 mm ports were inserted at the left lower quadrant. The scope was introduced through the supraumbilical port. After isolating a segment of the sigmoid using 2 endoscopic staplers an incision was made in the deepest part of the vestibule. Performing a blunt dissection a 2-finger wide space was created between the urethra, bladder and rectum. In the top of the space the peritoneum was incised under laparoscopic control, which allowed passage of the forceps from the perineum and enabled descent of the isolated sigmoid segment. The graft was fixed to the mucosa of the vaginal vestibule using a single suture. The continuity of the intestinal tract was restored using a circular mechanical suture through the rectum. RESULTS: Average operative time was 5 hours. None of the cases needed conversion to open surgery. No significant blood loss or any other complication was noted. Average postoperative stay was 7 to 9 days. CONCLUSIONS: This preliminary report suggests that laparoscopic sigmoid vaginal replacement is feasible and safe, and may be used as an alternative to open surgery.
PURPOSE:Sigmoid vaginoplasty is an alternative technique for vaginal replacement. We describe the successful use of laparoscopy for reconstruction of a vagina in patients with the Mayer-Rokitansky-Kuster-Hauser syndrome. MATERIALS AND METHODS: Laparoscopic surgery was performed in 5 girls with a mean age of 17 years and 5 months. We used 4 ports, the first of which was inserted supraumbilically by the Hasson technique. The next 10 mm port was introduced through the right lower quadrant under visual control. Then 5 and 15 mm ports were inserted at the left lower quadrant. The scope was introduced through the supraumbilical port. After isolating a segment of the sigmoid using 2 endoscopic staplers an incision was made in the deepest part of the vestibule. Performing a blunt dissection a 2-finger wide space was created between the urethra, bladder and rectum. In the top of the space the peritoneum was incised under laparoscopic control, which allowed passage of the forceps from the perineum and enabled descent of the isolated sigmoid segment. The graft was fixed to the mucosa of the vaginal vestibule using a single suture. The continuity of the intestinal tract was restored using a circular mechanical suture through the rectum. RESULTS: Average operative time was 5 hours. None of the cases needed conversion to open surgery. No significant blood loss or any other complication was noted. Average postoperative stay was 7 to 9 days. CONCLUSIONS: This preliminary report suggests that laparoscopic sigmoid vaginal replacement is feasible and safe, and may be used as an alternative to open surgery.