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Laparoscopic Vecchietti procedure: pearls for success
Jensara Clay1, Cecile Ferrando1, Thomas Gallant1
1Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.
Objective:
To present an effective strategy for optimizing the care of patients with Müllerian agenesis who desire surgical management for the creation of a neovagina with the laparoscopic Vecchietti procedure.
Design:
This video provides a framework for patient evaluation and selection, surgical strategy, and postoperative care regimen to provide optimal postprocedural outcomes.
Setting:
Academic Hospital.
Patient(S):
This is a 22-year-old patient with Müllerian agenesis who was unsuccessful with conservative strategies for vaginal lengthening and sought care for neovagina creation.
Intervention(S):
The patient underwent preoperative pelvic floor physical therapy and vaginal dilation, both of which were ineffective in producing adequate vaginal lengthening. We then performed a laparoscopic Vecchietti procedure. The procedure occurred at a large academic institution with two obstetrics-gynecology subspecialty surgeons providing perioperative care.
Main Outcome Measure(S):
A vaginal length of 7 cm was achieved, which was sustained at >12 months.
Result(S):
The patient was managed by a multidisciplinary team using our established care regimen, with follow-up demonstrating a sustained positive treatment outcome. The vaginal length at more than 1 year after the procedure measured 7 cm.
Conclusion(S):
Using a methodological, patient-focused approach and an experienced multidisciplinary team can optimize immediate- and long-term surgical outcomes for patients with Müllerian anomalies who do not have acceptable success with conservative methods.
