Robotic-assisted Reconstruction of the Cervix and Vagina by Small Intestinal Submucosa Graft and Fusion of the Hemiuterus

Abstract

Study ObjectiveTo describe our technique of robotic-assisted reconstruction of the cervix and vagina using a small intestinal submucosa (SIS) graft and fusion of the hemiuterus. DesignA step-by-step explanation of the procedure using video. SettingCongenital complete vaginal and cervical atresia is rare. Some patients have urinary system abnormality. No standardized surgical treatment guideline was available, and the performance varies for each patient. InterventionsWe performed a robotic-assisted reconstruction of the cervix and vagina using an SIS graft (Cook Medical, Bloomington, IN) and fusion of the hemiuterus for a 12-year-old girl from China diagnosed with congenital vaginal and cervical atresia (U4C4V4). She complained of severe abdominal periodic pain for 2 months. Mammary development and her serum sex hormone were within normal range. The patient has a single kidney. The diagnosis was made according to clinical characteristics, physical examination, and magnetic resonance imaging and classified using the European Society of Human Reproduction and Embryology /European Society for Gynaecological Endoscopy (ESHRE/ESGE) system. There was a hematometra of 7-cm diameter in her pelvis. We constructed a novel vagina by sharp and blunt separation and connected it to the uterine cavity. With the SIS graft, we reconstructed her cervix and vagina, and we fused the hemiuterus to make the uterine cavity spacious. The operating time was 260 minutes, and blood loss was 300 mL. She recovered well after the operation without any complications. After surgery, the patient has had normal menstruation without pain. She insists on wearing the vaginal mold 24 hours per day. The follow-up was 10 months. The length of the vagina was 9 cm and the width was 3 cm. ConclusionRobotic-assisted reconstruction of the cervix and vagina using an SIS graft and fusion of the hemiuterus is feasible and safety. However, additional studies are required.