Transumbilical Vaginoplasty Through Fractionated Miniports

Abstract

BACKGROUND: Vaginal agenesis is a müllerian anomaly characterized by congenital absence of the vagina. In this case series, the authors describe a novel, minimally invasive technique using microport entry for treatment of complete vaginal agenesis. TECHNIQUE: A balloon catheter is passed through a fenestrated perfluoroalkoxy polymer resin–supporting platform, then tied by a silk suture over the caudal end of the inserter. Two 4-mm microports are created intraumbilically; one to insert the scope and the other to introduce the catheter inserter that is advanced under direct vision. The inserter loaded with a catheter is passed across the pelvic floor to position the balloon at the vaginal dimple. The balloon is inflated and tightly positioned against the dimple. The perfluoroalkoxy polymer resin piece is clamped at the umbilicus. Traction is applied to the catheter stem and increased progressively to achieve desired vaginal depth. EXPERIENCE: Twenty-two women aged 17–28 years with vaginal agenesis underwent microport vaginoplasty. Twenty-one women were diagnosed with müllerian agenesis and one patient with androgen insensitivity syndrome. Preoperative vaginal depth ranged between 0.5 and 3 cm. The procedure was well tolerated with no intraoperative or postoperative complications. Patients achieved neovaginal depth between 9 and 11 cm and penetrations scores increased to 80–90%. CONCLUSION: Microport vaginoplasty is a feasible and effective procedure for management of vaginal agenesis.