Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China.
Department of Ultrasound, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China.
Fertil Steril. 2020 Mar;113(3):681-682. doi: 10.1016/j.fertnstert.2019.11.011.
To introduce an innovation that combines single port laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum (U2aC4V4).
Video article introducing a new surgical technique.
University hospital.
PATIENT(S): A 15-year-old patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum had primary amenorrhea and cyclic lower abdominal pain. The magnetic resonance imaging did not show hematometra and the endometrium was 6 mm when she had lower abdominal pain.
INTERVENTION(S): A neovagina (depth, 7 cm; width, 2.5 cm) was created using the Wharton-Sheares-George neovaginoplasty. By single laparoscopy, the bladder was separated from the anterior surface of the uterus. With the mold in the neovagina created by the assistant, the apex of neovagina was opened. Then the lower uterine segment was exposed and incised. A T-shaped intrauterine device was connected to an 8-cm-long catheter scissored from a 14-F Foley catheter and was inserted into the uterus to prevent cervical or vaginal stenosis. The upper end of the graft was applied onto the lower uterine segment with delayed absorbable sutures. The lower end was sutured to the high vaginal or vestibular mucosa.
MAIN OUTCOME MEASURE(S): The feasibility and effect of combination single port laparoscopic with vaginal cervicovaginal reconstruction in the congenital atresia of cervix.
RESULT(S): The operation was successful. The operating time was 90 minutes. Hospitalization was 3 days. There were no intraoperative and postoperative complications. The patient had resumption of menses at three cycles postoperatively, and she had no dysmenorrhea. No cervical or vaginal stenosis occurred because of the Foley catheter.
CONCLUSION(S): Single port laparoscopic combined with vaginal cervicovaginal reconstruction provided a minimally invasive, safe, and effective surgical option for the young patient with congenital atresia of cervix. It was successful and without complications or cervical or vaginal stenosis.
介绍一种创新的手术方法，将单孔腹腔镜技术与 Wharton-Sheares-George 宫颈阴道重建术相结合，使用小肠黏膜下基质（SIS）移植物治疗先天性宫颈闭锁、阴道缺失和不完全子宫纵隔（U2aC4V4）患者。
视频文章介绍一种新的手术技术。
大学医院。
一名 15 岁的先天性宫颈闭锁、阴道缺失和不完全子宫纵隔患者，原发性闭经，周期性下腹痛。磁共振成像未显示宫腔积血，腹痛时子宫内膜厚 6mm。
使用 Wharton-Sheares-George 阴道成形术构建新阴道（深度 7cm，宽度 2.5cm）。通过单腹腔镜，将膀胱与子宫前表面分离。助手在新阴道模具中，将新阴道的顶端打开。然后暴露并切开下段子宫。将 T 型宫内节育器连接到从 14-F Foley 导管剪断的 8cm 长导管，并插入子宫，以防止宫颈或阴道狭窄。移植物的上端用可吸收延迟缝线应用于下段子宫，下端缝合至阴道或前庭黏膜。
先天性宫颈闭锁的单孔腹腔镜联合阴道宫颈重建的可行性和效果。
手术成功。手术时间为 90 分钟。住院 3 天。无术中及术后并发症。术后 3 周期恢复月经，无痛经。由于 Foley 导管的存在，没有发生宫颈或阴道狭窄。
单孔腹腔镜联合阴道宫颈重建为先天性宫颈闭锁的年轻患者提供了一种微创、安全、有效的手术选择。手术成功，无并发症，无宫颈或阴道狭窄。
