Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence

Abstract

Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer–Rokitansky–Küster–Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5 cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5–7 days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10–11 cm neovaginas in 1 week; six weeks after surgery all patients had an epithelized 10.5–12 cm length and 2.5–3 cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.

Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery

“…Therefore, it is necessary to increase the evidence level by applying it to larger populations in multiple centers. In addition, this technique should also be applied to patients with severe endometriosis, gynecologic malignancy, or congenital anomalies, which were reported by Ianieri et al but lacking in this study [ 16 , 27 , 28 ]. Fourth, intraureteral instillation is an off-label use compared to intravenous injection of ICG, which has already been approved for use by the FDA; therefore, safety should be proven in more cases.…”

Isolation of Vaginal Epithelial Cells: In Preparation of Autologous Vaginal Tissue Lining for Congenital Absence of Vagina Patients

“…Pelvic magnetic resonance imaging (MRI) of the first patient showed clotted blood filling the uterine cavity and drainage was conducted to relieve lower abdominal pain, while the pelvic MRI results of the second patient revealed an 8 cm-sized chocolate cyst in the left ovary, which was removed via left ovarian cystectomy. In another case reported by Oliveira and Ferreira [6], an 18-year-old patient diagnosed with uterine and vaginal agenesis underwent a mini-laparoscopic modified Vecchietti procedure for neovaginal creation. A two-step procedure of vaginal intervention entails the creation of a neovagina and later anastomosis of the uterus with the newly created vagina, which requires the establishment of an autologous vaginal tissue lining.…”

Utilization of Indocyanine Green (ICG) Fluorescence in Patients with Pediatric Colorectal Diseases: The Current Applications and Reported Outcomes

“…One study outlined the use of ICG for ureteric mapping, applied through cystoscopic access, which supported anomaly screening and aided in the careful dissection of the retrovesical space. This approach has significantly mitigated the risk of inadvertently harming the urinary tract during surgery [ 43 ].…”

“…For example, enteral ICG administration through a distal colostomy is utilized for visualizing rectourethral fistulas in PSARP procedures, potentially decreasing complications like ROOF [ 41 , 65 ]. Similarly, ICG injection into the urinary system has been employed to safeguard against injuries during dissection and assist in identifying urinary anomalies in patients with MRKH syndrome [ 43 ].…”