From the Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France (all authors)..
From the Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France (all authors).
J Minim Invasive Gynecol. 2021 Sep;28(9):1564. doi: 10.1016/j.jmig.2021.02.003. Epub 2021 Feb 6.
To describe the different steps of the Davydov surgical technique for creating a neovagina, emphasizing visualization of the rectovesical cleavage and peritoneal-vaginal anastomosis by laparoscopic and vaginal approaches.
Production of a step-by-step surgical video tutorial with narrative video footage.
Uterovaginal agenesis is a rare congenital defect, observed in 1 case per 4000 to 5000 newborn female infants [1]. Vaginal agenesis treatment can be performed by different nonsurgical and surgical techniques that are based on neocavity creation. The Davydov intervention uses the pelvic peritoneum as "covering" tissue for a neocavity and avoids the use of allogenic or autologous transplants, traction devices, or specialized surgical equipment. It is a minimally invasive technique that provides long-term functionality and anatomically satisfying results [2].
We treated an 18-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome who underwent the Davydov procedure after dissatisfaction with the Franck self-expansion method. We created a neovagina using peritoneal flaps that were obtained after rectovesical cleavage by laparoscopic approach and were then fastened to the introitus by vaginal approach. Finally, the vaginal vault was reconstructed laparoscopically, and an intravaginal dilator was left in place. The result after 1 year showed the transition from a narrow vaginal dimple 2 cm in length to a neovagina 10 cm in length, permeable, well epithelialized, and correctly healed without associated stenosis. Sexual intercourse is satisfying for both partners.
The Davydov technique is less invasive than other surgical techniques and allows good outcomes [3,4] without the invasive use of sigmoidal grafts, cutaneous flaps, or prostheses. It should be proposed to patients experiencing failure with the Franck nonsurgical method.
描述 Davydov 外科手术创建新阴道的不同步骤，重点介绍腹腔镜和阴道入路下观察直肠-阴道间隙和腹膜-阴道吻合的方法。
制作分步手术视频教程，配有叙事视频片段。
子宫阴道发育不全是一种罕见的先天性缺陷，每 4000 至 5000 名新生女婴中就有 1 例[1]。阴道发育不全的治疗可以通过不同的非手术和手术技术来进行，这些技术都是基于创建新腔。Davydov 干预措施使用骨盆腹膜作为新腔的“覆盖”组织，避免使用同种异体或自体移植物、牵引装置或专门的手术设备。这是一种微创技术，可以提供长期的功能和解剖上满意的结果[2]。
我们治疗了一位 18 岁的 Mayer-Rokitansky-Küster-Hauser 综合征患者，她对 Franck 自我扩张方法不满意，因此接受了 Davydov 手术。我们通过腹腔镜入路在直肠-阴道间隙获得腹膜瓣，然后通过阴道入路将其固定到阴道入口，从而创建新阴道。最后，通过腹腔镜重建阴道穹窿，并放置阴道内扩张器。1 年后的结果显示，从长度为 2 厘米的狭窄阴道凹痕过渡到 10 厘米长、可渗透、上皮化良好、正确愈合且无相关狭窄的新阴道。性满足感对双方伴侣都很好。
与其他手术技术相比，Davydov 技术的侵入性更小[3,4]，无需侵入性使用乙状结肠移植物、皮瓣或假体。对于 Franck 非手术方法失败的患者，应建议使用该技术。
