V1548 COMBINED ROBOT ASSISTED AND PURE LAPAROSCOPIC ILEAL NEOVAGINA CREATION UTILIZING ROBOT SIDE DOCKING AND LAPAROSCOPIC PERINEAL PORT PLACEMENT

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2010V1548 COMBINED ROBOT ASSISTED AND PURE LAPAROSCOPIC ILEAL NEOVAGINA CREATION UTILIZING ROBOT SIDE DOCKING AND LAPAROSCOPIC PERINEAL PORT PLACEMENT James Brien, Britton Tisdale, Jeremy Tonkin, Michael Fabrizio, and Gerald Jordan James BrienJames Brien More articles by this author , Britton TisdaleBritton Tisdale More articles by this author , Jeremy TonkinJeremy Tonkin More articles by this author , Michael FabrizioMichael Fabrizio More articles by this author , and Gerald JordanGerald Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1300AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome affects at least 1 out of 4500 women, and is characterized by varying degrees of vaginal aplasia, as well as other malformations. Neovaginal construction is possible using several techniques, although no single method is considered ideal. Use of ileum for neovaginal construction is well described, although challenging to accomplish using minimally invasive techniques. We present a case of combined robotic assisted and pure laparoscopic ileal neovagina creation in a MRKH female with complete vaginal agenesis and a solitary pelvic kidney. METHODS Patient positioning was in low lithotomy. After mobilization of ascending colon and terminal ileum, The da Vinci robot was docked on the left side of the patient to allow for simultaneous laparoscopy and perineal access. After dissection of the vaginal plate, a 10-12mm port was placed through the area corresponding to the neovaginal hiatus. The perineal port was useful in the selection and dissection of the ileal segment identified for creation of the neovagina, transilluminating mesentery vascular arcades prior to division, and facilitating construction of the ileal-ileal reanastomosis. The neovaginal ileal segment was transposed to the perineum and matured with interrupted sutures after pull through to the neovaginal hiatus. RESULTS Total operative time was 7 hours 24 minutes and estimated blood loss was 100cc. The patient experienced no significant post-operative complications and was discharged on post operative day 7. Neovaginal cosmesis was good. Hiatus of neovagina was of good caliber and depth of the vaginal limb was sufficient. CONCLUSIONS Combined pure laparoscopy and robotic assisted laparoscopy with robot side docking and placement of a perineal intraperitoneal port is an alternative minimally invasive option for creation of an ileal neovagina while avoiding the morbidity of a laparotomy. Norfolk, VA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e596-e597 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Brien More articles by this author Britton Tisdale More articles by this author Jeremy Tonkin More articles by this author Michael Fabrizio More articles by this author Gerald Jordan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...