A Minimally Invasive Approach for Laparoscopic-Perineal Sigmoid Colpoplasty: Case Report and Innovations

Abstract

BACKGROUND Laparoscopic-perineal neovagina construction by sigmoid colpoplasty is a popular therapeutic approach for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The conventional approach requires an auxiliary abdominal incision to exteriorize the descending colon to fix the anvil for end-to-end colorectal anastomosis. We modified the natural orifice specimen extraction surgery (NOSES) approach by exteriorizing the descending colon through the artificial neovaginal tunnel to replace the anvil extracorporeally, without requiring an auxiliary abdominal incision. It was a more minimally invasive technique. CASE REPORT We performed this modified laparoscopic-perineal sigmoid colpoplasty in a 26-year-old woman with MRKH syndrome. We cut off a segment of the sigmoid colon with a vascular pedicle to make a new vagina out of it, the same as in the traditional laparoscopic-perineal sigmoid colpoplasty. What is new about this technique is that it has no need for abdominal incision and is more minimally invasive. The operating time was 315 min. No postoperative complications occurred. The postoperative hospital stay was 4 days. The modified laparoscopic-perineal approach, free from an auxiliary abdominal incision, demonstrated advantages, including a shorter hospital stay, expedited recovery, and comparable anatomical outcomes, when compared with the traditional approach. This innovation improves the surgical experience for patients with MRKH syndrome, addressing the physical and psychological aspects of their condition. CONCLUSIONS This refined laparoscopic-perineal neovagina construction by sigmoid colpoplasty represents a feasible and minimally invasive technique. It is an attractive option for MRKH syndrome patients in need of vaginal reconstruction, offering a streamlined procedure with reduced postoperative recovery time and enhanced patient outcomes.

Figure 1.

Building the neovaginal tunnel. (A) An incision was made in the vestibular mucosa; (B) the neovaginal tunnel was 8 cm in length.

Figure 2.

Constructing the pedicle sigmoid flap and exteriorizing the descending colon through the artificial neovaginal tunnel. (A) Releasing the sigmoid and upper rectum. (B, C) Building a pedicle sigmoid flap. (D, E) Pulling out the descending colon through the artificial neovaginal tunnel. (F) Fixing an anvil at the descending colon stump through the neovaginal tunnel.

Figure 3.

Suturing the distal end of the pedicle sigmoid flap onto the perineal skin. (A) Abdominal cavity view and (B) perineum view.

Figure 4.

(A–C) End-to-end colorectal anastomosis through the anus.

Figure 5.

Diagram of the modified laparoscopic-perineal sigmoid colpoplasty. (A) Construction of the pedicle sigmoid flap. (B) Pulling out the end of descending colon through the artificial neovaginal tunnel. (C) Fixing an anvil at the descending colon stump. (D) Suturing the distal end of the pedicle sigmoid flap onto the perineal skin. (E) End-to-end colorectal anastomosis through the anus. (F) Completed the digestive tract reconstruction and neovagina construction. Drawn by Dr. Shi-yu Xu, Chuang-qi Chen surgical team.