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Transumbilical Vaginoplasty Through Fractionated Miniports

A Sutureless Procedure

El Saman, Ali M. MD; Abou-Taleb, Hesham MD; Khalaf, Mohamed MD; Salama, Mohamed H. MD; Habib, Dina M. MD; Bahlol, Mostafa MD; Eleraky, Alshymaa H. MBBCh; El Saman, Dina A.; Eldeen, Sabaa Shogaa MD; Shazly, Sherif A. MBBCh

doi: 10.1097/AOG.0000000000003307
Contents: Minimally Invasive Surgery: Procedures and Instruments
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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.

Minimally invasive vaginoplasty using fractionated miniports is an effective approach that can be used to construct a neovagina for treatment of complete vaginal aplasia.

Women Health Hospital, Department of Obstetrics and Gynecology, and Faculty of Medicine, Assiut University, Assiut, and the Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt; the Department of Obstetrics and Gynecology, Sanaa University, Sanaa, Yemen; and the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.

Corresponding author: Ali M. El Saman, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt; email: ali_elsaman@yahoo.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B399.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.