Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. (Dr. Khan).
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. (Drs. Baker and Yunker).
CRSLS. 2024 Sep 17;11(2). doi: 10.4293/CRSLS.2024.00014. eCollection 2024 Apr-Jun.
While vaginal agenesis most often occurs with an absent or rudimentary, nonfunctioning uterus, it may also occur with a fully developed uterine body. In these scenarios, anastomosis of the functional uterus to a neovagina allows for both egress of menstrual blood as well as potential preservation of fertility: case reports exist of spontaneous conception following creation of a neovagina. However, prior attempts at anastomosis have all included delayed surgery with anastomosis to the uterus several months following the creation of the neovagina.
The patient was a 17-year-old female who presented with amenorrhea several years after thelarche. After noting a blind ending vagina and a 46XX karyotype, ultrasound and MRI revealed an apparently normal uterus with questionable presence of a cervix, and polycystic appearing ovaries, which may have accounted for the patients minimal hematometra. A multidisciplinary team including gynecology, urology, plastic surgery, and colorectal surgery was organized for creation of a neovagina and attempted anastomosis to the normal appearing uterus. In a single staged robotic procedure, a peritoneal neovagina created in a modified Davydov technique was successfully connected to the uterus. A foley catheter was placed in the uterine cavity to allow for canalization. Diagnostic hysteroscopy six weeks after surgery confirmed a canal into the uterus, and the patient reported ongoing cyclical bleeding with the use of oral contraceptives several months after surgery.
In vaginal agenesis with a functional upper reproductive tract, peritoneal neovaginas may be successfully anastomosed to the uterus in a single stage robotic approach.
阴道发育不全通常伴有缺失或发育不全、无功能的子宫，但也可能与完全发育的子宫体同时存在。在这些情况下，将功能性子宫与新阴道吻合，既可以使月经血排出，又可以保留生育能力：有报道称，在新阴道形成后，自然受孕。然而，之前的吻合尝试都包括延迟手术，即在新阴道形成几个月后进行子宫吻合。
患者为 17 岁女性，初潮后数年出现闭经。在发现盲端阴道和 46XX 核型后，超声和 MRI 显示子宫明显正常，但宫颈可疑存在，卵巢呈多囊样，这可能导致患者的子宫积血较少。一个多学科团队，包括妇科、泌尿科、整形外科和结直肠外科，被组织起来创建一个新阴道，并尝试将其与正常的子宫进行吻合。在一个单一的机器人手术阶段，一个采用改良 Davydov 技术的腹膜新阴道成功地与子宫相连。子宫腔内放置了 Foley 导管以进行通道化。手术后 6 周的诊断性宫腔镜检查证实了子宫内的通道，并且患者在手术后几个月报告说在使用口服避孕药时有持续的周期性出血。
在有功能性上生殖道的阴道发育不全中，腹膜新阴道可以通过单一阶段的机器人方法成功地与子宫吻合。
