Ultrasound-assisted laparoscopic creation of a neovagina by modification of Vecchietti's operation

Background: In performing Vecchietti's operation laparoscopically, it is im portant to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease an d speed of this operation. Technique: The pneumoperitoneum is emptied and the bladder filled with 200 mt of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorect al space, with ultrasound guidance, and its emergence into the pelvis is co ntrolled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. Experience: Seven patients with vaginal aplasia had this procedure. There w ere no complications, and the mean operative time was 43 minutes (range 35- 55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual i ntercourse as very satisfying and two as moderately satisfying. Conclusion: This original technique was used for easy, safe, and rapid crea tion of neovaginas. (C) 1999 by The American College of Obstetricians and G ynecologists.