Laparoscopic modified Davydov's technique for vaginoplasty: operative steps and technical pearls

Müllerian agenesis syndrome is a congenital condition characterized by uterine and vaginal agenesis in women with normal 46,XX karyotype, normal ovarian function, and normal secondary sexual characteristics. It represents one of the most challenging causes of primary amenorrhea, with significant anatomical, functional, and psychological implications. Several surgical and non-surgical techniques have been proposed for vaginal reconstruction; however, no universally accepted standard exists. Among surgical options, the laparoscopic Davydov procedure has gained wide acceptance due to its minimal invasiveness and favorable anatomical and functional outcomes. This video article presents a standardized laparoscopic Davydov neovaginoplasty, illustrating key anatomical landmarks and technical steps. We report the case of a 21-year-old woman with Müllerian agenesis, no relevant medical history, and primary amenorrhea, who underwent a combined laparoscopic and vaginal approach. Following laparoscopic inspection, the peritoneum between the bladder and rectum was incised, and the recto-vesical space was developed. A 12-mm trocar was inserted transperineally to guide the anastomosis of the mobilized peritoneum to the vaginal vestibular mucosa, thereby creating a continuous neovaginal canal. At 6-month follow-up, vaginoscopy showed a well-epithelialized, iodine-positive neovaginal mucosa with a final vaginal length of 11 cm. No urinary or functional complications were reported. This video demonstrates a standardized and teachable laparoscopic technique that may contribute to improving functional and psychosocial outcomes in patients with Müllerian agenesis.