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.
DESIGN: Prospective comparative interventional study.
SETTING: University hospital. PATIENT(S): One hundred one patients with congenital vaginal agenesis. INTERVENTION(S): The interventions compared were [1] a new laparoscopic, Vecchietti-based method using vaginoabdominal blunt perforation without vesicorectal tunneling and [2] the laparoscopic Vecchietti procedure. MAIN OUTCOME MEASURE(S): Duration of surgery and traction, functional results, surgical and technical complications. RESULT(S): 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. CONCLUSION(S): 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.