Presentation Authors: Ervin Kocjancic, Omer Acar*, David Greenwald, Ryan Dobbs, Whitney Halgrimson, Simone Crivellaro, Chicago, IL
Introduction: Mayer Rokitansky Kuster Hauser syndrome (MRKH) is a congenital malformation characterized by a failure of the Mullerian duct to develop resulting in variable degrees of vaginal hypoplasia. Many techniques have been described to reconstruct a vagina with satisfactory sexual function and appearance in this setting. The Davydov technique; includes liberation of peritoneum from the pelvic side walls and the Pouch of Douglas. Neovagina is then created by suturing a vaginal inner lining and roof of peritoneum. A combined laparoscopic and perineal approach suits well for this procedure. Herein, we aim to demonstrate the technique, advantages and outcome after robot-assisted laparoscopic vaginoplasty with the Davydov technique in patient diagnosed with MRKH syndrome.
Methods: An 18-year-old, genotypically and phenotypically female patient presented to the clinic due to primary amenorrhea and inability to have vaginal intercourse. Her past medical and surgical history were unremarkable. Physical examination findings were consistent with vaginal aplasia. Basic urine and blood work-up revealed normal findings. Abdominopelvic MRI confirmed the deficiency of Mullerian duct structures. The available options for vaginal reconstruction were discussed. Final decision was to proceed with robotic vaginoplasty with the Davydov technique.
Results: The procedure was conducted under general anesthesia with the patient in lithotomy position. A total of 5 transperitoneal ports were inserted. A limited space was created perineally with sharp and blunt dissection carried along the tract between urethral meatus and perianal ring. Peritoneal flaps were harvested from pelvic side walls via laparoscopic access. Anterior and posterior peritoneal flaps were transposed and suture-fixated to the neo-introitus. Peritoneal defects and vaginal apex was closed by running sutures. Intraoperative vaginal depth was 10cm. Neo-vagina was filled with a spacer. Operative duration was 216min. Estimated blood loss amount was 50ml. Vaginal spacer and foley catheter was removed on postoperative day 3. She was discharged home on postoperative day 4 after an uneventful course.
Conclusions: Davydov technique is a safe and effective way of vaginal construction in patients diagnosed with MRKH syndrome. Robot-assisted laparoscopic access provides technical ease regarding the harvest and perineal transposition of sufficient peritoneal tissue. Avoiding the use of bowel segments accelerates the recovery process and minimizes the risk of postoperative complications.