Kanyaka Women's Clinic, Mumbai, India.
Naval Multispeciality Hospital, Jalgaon, India.
J Minim Invasive Gynecol. 2018 Feb;25(2):334-335. doi: 10.1016/j.jmig.2017.07.016. Epub 2017 Jul 24.
Isolated cervical agenesis occurs in 1 in 80 000 to 100 000 births. According to the American Fertility Society, cervical agenesis should be classified as a type Ib müllerian anomaly. According to ESHRE/ESGE classification, it is classified in class C4 category. Here we demonstrate the possibility of an innovative surgery for the management of cervical agenesis.
Stepwise description of laparoscopic uterovaginal anastomosis (Canadian Task Force classification II-3).
Video.
A 13-year-old girl.
Laparoscopic uterovaginal anastomosis was performed. Informed consent was taken from the patient for use of video and images. Institutional review board has ruled that approval was not required for this study.
This video demonstrates the management of a case of a 13-year-old girl with primary amenorrhea and cyclical lower abdominal pain for 5 months. After complete examination and investigation, a diagnosis of isolated cervical agenesis with hematomata and blind-ending vagina was made. An innovative technique was used to perform laparoscopic uterovaginal anastomosis. Later, a hysteroscopy was done that revealed patency of anastomoses. As a result, the patient is experiencing spontaneous regular menstruation for 48 months. The main steps of the procedure were as follows: A follow-up hysteroscopy was performed at 9 weeks after surgery. It showed patent anastomosis and normal uterine cavity. After 48 months, a repeat hysteroscopy was done and a partial fibrotic septum noted. It was resected using electric energy.
Uterovaginal anastomosis for isolated cervical agenesis is possible by a minimally invasive approach. It can be offered as a first-line management for such cases over hysterectomy and cervical canalization, which have high complication rates. The surgery should only be performed by a specialized team with required expertise in minimally invasive surgery.
孤立性宫颈发育不全的发生率为每 80000 至 100000 例出生 1 例。根据美国生殖医学学会的分类，宫颈发育不全应归类为 Ib 型米勒管发育不全。根据 ESHRE/ESGE 分类，它被归类为 C4 类。在这里，我们展示了一种用于管理宫颈发育不全的创新手术的可能性。
腹腔镜子宫阴道吻合术的逐步描述（加拿大任务组分类 II-3）。
视频。
一名 13 岁女孩。
进行腹腔镜子宫阴道吻合术。患者已获得使用视频和图像的知情同意。机构审查委员会已裁定，本研究无需批准。
该视频演示了对一名 13 岁女孩的病例管理，该女孩初潮后出现周期性下腹痛 5 个月。经过全面检查和调查，诊断为孤立性宫颈发育不全伴血肿和盲端阴道。采用创新技术行腹腔镜子宫阴道吻合术。随后进行宫腔镜检查，显示吻合口通畅。结果，患者经历了 48 个月的自发性定期月经。该过程的主要步骤如下：手术后 9 周进行了随访宫腔镜检查。显示吻合口通畅，子宫腔正常。48 个月后，再次进行宫腔镜检查，发现部分纤维性隔膜。使用电能切除。
通过微创方法对孤立性宫颈发育不全进行子宫阴道吻合术是可行的。对于此类病例，它可以作为子宫切除术和宫颈扩张术的一线治疗方法，因为这两种方法的并发症发生率较高。该手术只能由具有微创外科专业知识的专业团队进行。
