Dear Editor,
In our previous article,[1] a rare case of cervicovaginal agenesis was managed by laparotomy and cervicovaginoplasty and the importance of uterine conservative surgeries over hysterectomy was discussed. Whenever feasible, a minimally invasive approach should be preferred. With the advent of time, improved surgical skill, and growing learning curve, we managed our next case of cervicovaginal agenesis laparoscopically. The aim of this report is to share the steps of laparoscopic cervicovaginoplasty in a simplified manner.
A 12-year-old girl presented with primary amenorrhea and cyclical pain abdomen for 4 months. Secondary sexual characteristics were appropriate for age. Local examination revealed blind vaginal pouch [Figure 1a]. On rectal examination, no cervix-like structure was felt and the uterus was of normal size. Magnetic resonance imaging pelvis was suggestive of cervicovaginal agenesis. A plan of laparoscopic cervicovaginoplasty was made.
Figure 1.
(a) Blind vaginal pouch; (b) opening of uterine cavity laparoscopically; (c) long instrument inserted towards neovagina; (d) formation of the neocervix; (e) Malecot catheter inserted in the uterine cavity through the neocervix; (f) A sterile foam mold encircling Malecot placed in the neovagina
Initially, the patient was placed in lithotomy position, and an approximately 6 cm × 3 cm neovagina was created with careful dissection between bladder and rectum. On laparoscopy, the uterus was normal sized and the bilateral tubes and ovaries were healthy. A ~2 cm vertical midline incision was made over the uterine fundus toward the anterior wall and the uterine cavity was entered. To create a neocervix (connection between uterus and vagina), a long laparoscopic instrument was inserted via uterine cavity as a guide and a vaginal incision was given over the protrusion of guide. A silicone Malecot catheter 18 Fr was inserted in the uterine cavity via the neocervix by rail-road technique and retained in situ as a stent. Uterine incision was sutured with delayed absorbable suture. A sterile foam mold encircling Malecot catheter was placed in the neovagina [Figure 1b-f]. Foam mold was replaced with glass mold on the 7th postoperative day, while the Malecot catheter left in situ. The patient has got normal menses for 12 months and in regular follow-up.
Cervicovaginal agenesis in the presence of uterus is a rare condition. Laparoscopic cervicovaginoplasty provides a minimally invasive, safe, and efficacious management option and should be offered as a first-line treatment over other modalities.[2]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
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