CREATION OF NEOVAGINA: LAPAROSCOPIC VECCHIETTI OPERATION

W. Hilger and J. Magrina

Mayo Clinic, Scottsdale, AZ

OBJECTIVE: To demonstrate the surgical anatomy and technique of the laparoscopic Vecchietti operation for the creation of a neovagina.

MATERIALS AND METHODS: This video demonstrates the minimally invasive technique of creation of a neovagina in a 17-year old female with Rokitansky syndrome. The patient had initially presented at 15-years old with complaints of pelvic pain and amenorrhea. Exam and MRI revealed a 1 cm vaginal dimple, a rudimentary uterine horn, normal ovaries bilaterally and no renal defects. The patient underwent a laparoscopic resection of the rudimentary uterine horn and excision of endometriotic implants.  Two years later the patient desired a functioning vagina. The patient failed vaginal dilators and surgical treatment was offered. This video reviews the technique of laparoscopic Vecchietti operation. The anatomy, surgical technique and instrumentation are reviewed. Specifically, passage of suture through the pseudohymeneal membrane from below, retrieval of the suture from above through laparoscopic port sites and use of the Vecchietti olive and traction device are shown.

RESULTS: The patient tolerated the procedure well and when the traction device was removed on postoperative day 7 the vagina had 10 cm of length. A vaginal mold and dilators were used after removal of the traction device and by postoperative day 18 a medium graves speculum could be inserted without difficulty. By 4 months postoperative a #10 lucite dilator could be used without difficulty and almost complete epithelialization of the vagina was noted. Three years after the operation the patient is married and reports no difficulties with intercourse.

CONCLUSIONS:  The laparoscopic Vecchietti procedure is a minimally invasive operation for creation of an anatomically and functionally acceptable neovagina.  It is a preferable alternative to more invasive procedures and for patients who refuse or fail manual dilators.

Key Words: neovagina, laparoscopy, Vecchietti

Disclosure – Nothing to disclose.