Surgical Video Tutorial: Treatment of Congenital Vaginal Agenesis: Laparoscopic Modified Davydov in 8 Steps
| Autor: | Olivier Garbin, Mégane Wehr, Thomas Schwaab, Aline Host, Emilie Faller, Cherif Akladios, Muriel Vermel, Lise Lecointre |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Vaginal approach
medicine.medical_specialty 46 XX Disorders of Sex Development Adolescent Anastomosis Surgically-Created Structures Introitus Congenital Abnormalities 03 medical and health sciences Gynecologic Surgical Procedures 0302 clinical medicine Humans Medicine Pelvic peritoneum Mullerian Ducts 030219 obstetrics & reproductive medicine business.industry Infant Newborn Obstetrics and Gynecology medicine.disease Surgery Stenosis Treatment Outcome 030220 oncology & carcinogenesis Agenesis Vagina Female Laparoscopy Vaginal vault Vaginal agenesis business |
| Zdroj: | Journal of Minimally Invasive Gynecology. 28:1564 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2021.02.003 |
| Popis: | Objective To describe the different steps of the Davydov surgical technique for creating a neovagina, emphasizing visualization of the rectovesical cleavage and peritoneal-vaginal anastomosis by laparoscopic and vaginal approaches. Design Production of a step-by-step surgical video tutorial with narrative video footage. Setting Uterovaginal agenesis is a rare congenital defect, observed in 1 case per 4000 to 5000 newborn female infants [1] . Vaginal agenesis treatment can be performed by different nonsurgical and surgical techniques that are based on neocavity creation. The Davydov intervention uses the pelvic peritoneum as “covering” tissue for a neocavity and avoids the use of allogenic or autologous transplants, traction devices, or specialized surgical equipment. It is a minimally invasive technique that provides long-term functionality and anatomically satisfying results [2] . Interventions We treated an 18-year-old patient with Mayer-Rokitansky-Kuster-Hauser syndrome who underwent the Davydov procedure after dissatisfaction with the Franck self-expansion method. We created a neovagina using peritoneal flaps that were obtained after rectovesical cleavage by laparoscopic approach and were then fastened to the introitus by vaginal approach. Finally, the vaginal vault was reconstructed laparoscopically, and an intravaginal dilator was left in place. The result after 1 year showed the transition from a narrow vaginal dimple 2 cm in length to a neovagina 10 cm in length, permeable, well epithelialized, and correctly healed without associated stenosis. Sexual intercourse is satisfying for both partners. Conclusion The Davydov technique is less invasive than other surgical techniques and allows good outcomes [ 3 , 4 ] without the invasive use of sigmoidal grafts, cutaneous flaps, or prostheses. It should be proposed to patients experiencing failure with the Franck nonsurgical method. |
| Databáze: | OpenAIRE |
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