Laparoscopic Upper Colpectomy for VAIN III after Previous Total Hysterectomy

Area of Science:

• Gynecologic Oncology
• Minimally Invasive Surgery
• Vaginal Pathology

Background:

• Vaginal intraepithelial neoplasia (VAIN) can occur after treatment for cervical dysplasia.
• Hysterectomy, while treating cervical conditions, does not eliminate the risk of VAIN.
• VAIN has a propensity for recurrence, often necessitating multiple interventions.

Purpose of the Study:

• To demonstrate the feasibility of laparoscopic upper colpectomy for VAIN treatment post-hysterectomy.
• To showcase a stepwise surgical technique for laparoscopic management of VAIN.
• To present a case study of successful laparoscopic upper colpectomy for extensive VAIN III.

Main Methods:

• A 60-year-old patient with severe dyskaryosis and subsequent VAIN III underwent laparoscopic upper colpectomy.
• Pre-operative colposcopy with acetic acid delineated the extent of VAIN.
• The procedure involved retroperitoneal access, pelvic sidewall dissection, and laparoscopic colpotomy using a McCartney tube.
• Vaginal closure was achieved with laparoscopic suturing.

Main Results:

• The laparoscopic upper colpectomy was successfully performed without intra- or postoperative complications.
• Histopathology confirmed a 65 × 35 × 8 mm specimen with VAIN III and clear margins.
• The patient achieved a normal vault smear post-procedure with no recurrence to date.

Conclusions:

• Laparoscopic upper colpectomy is a viable and effective treatment for vaginal intraepithelial neoplasia.
• This approach offers definitive management, potentially preventing recurrence associated with less invasive methods.
• The technique highlights the importance of careful pelvic dissection and anatomical identification in the post-hysterectomy setting.