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

Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options

“…The lining of the neovagina becomes re-epithelialised with normal vaginal mucosa. It was first described in 1965 via laparotomy and it is now mainly performed laparoscopically [Fedele et al, 1994;Brucker et al, 2008]. The major problem related to this procedure is the pain associated to the daily traction and the need to perform vaginal dilation after surgery to prevent neovaginal collapse.…”

Mayer-Rokitansky-Küster-Hauser Syndome and Laparoscopic Assisted Creation of Neovagina (Modified Vecchietti)

“…Previously, there was no consensus about the traction devices, various surgeons used their own methods. Report states that using 'Neovagina Set' which is developped, standardized and certificated for this operation, the operation duration becomes shorter with lesser morbidity in comparison with older non-standardized traction devices (5) .…”

“…Some authors prefer suprapubic installation, the others prefer umblical installation like us so the agenetic vagina is strecthed consistantly with the normal vaginal axis (5)(6)(7) . Generally, the advantages of the laparoscopical Vecchietti technique is short operation period, easy to learn, low morbidity, especially performable when pelvic renal abnormalities present, no need for lubricants during intercourse; the disadvantages are long hospitalisation period, long bladder catheterization period, post operative dilator requirement (5)(6)(7) . Furthermore the cost of the Neovagina Set itself and the high cost of long hospitalisation periods due to operative techiques are other disadvantages.…”

“…It is understood that both non-invasive techniques as applying serial dilatation, and invasive techniques as McIndoe, intestinal vaginoplasty, Vecchietti procedure, Davydov procedure, WhartonSheares-George procedure etc. are used to create a new vagina (3,(5)(6)(7)(8) . Although these operative technics have advantages and disadvantages, the common disadvantage of almost all of them is high morbidity.…”

“…In laparascopic modified Vecchietti procedure neovagina is created in the same way without dissection of rectovaginal space (5,6) . It is noticed in the historical course that various authors used different mechanisms and tools to stretch agenetic vagina in laparascopic Vecchietti operation.…”