Four Neovagina Techniques in the anatomical model

Sánchez-Ferrer M1, Acién-Sánchez M2

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes

Abstract 432
Video 2: Urethra and Gender Reconstruction
Scientific Podium Video Session 28
On-Demand
Anatomy Sexual Dysfunction Surgery Transgender
1. Hospital Clínico Universitario Virgen de la Arrixaca y Universidad de Murcia, 2. Hospital Clínico Universitario San Juan Alicante y Universidad Miguel Hernández de Elche
Presenter
M

María Luisa Sánchez-Ferrer

Links

Abstract

Introduction
Surgery for neovaginas in patients with vaginal agenesis is rare. The most commonly cited prevalence for vaginal agenesis in Rokitansky Sindrome  is 1 in 5000 (range 1 per 4000 to 10,000 females) [1]. The incidence of androgen insensitivity syndrome in females is 1:20,000.  In addition, recently with the increase in sex change surgery there is more interest in neovaginas surgery . Surgery is an option for women who have been unsuccessful with dilators or who prefer surgery after a thorough discussion of the advantages and disadvantages of the different techniques. In addition there are described in the literature different techniques of vaginal and laparoscopic approaches (Modified Mc Indoe, Vechietti, Davidov and vulvoperineal pediculated Flaps, …..) , all of them effective and without superiority of any of them. This relatively infrequent surgery should be performed in a few specialized centers, but the reality is that it is not regulated. Therefore, acquiring experience in this type of surgery is a challenge. Therefore, especially when dealing with rare numbers of operations of a special type, we must choose a technique that is simple, safe, and effective (2). Furthermore, rapid surgical innovation in minimally invasive procedures, devices, and surgical techniques have complicated the learning landscape. Fortunately, surgical simulation has evolved to fill the educational void. Whether it is through skill generalization or skill transfer, surgical simulation has shifted learning from the operating room back to the classroom. Educational simulation programs were necessary to improve specialist knowledge and skill and to facilitate competence in this kind of surgery. After carrying out a bibliographic search, we have not found publications on models to train these surgical techniques before performing them on patients. The aims of this abstract is  to show the usefulness of Thiel-embalmed cadaver models for training the surgical steps for four different surgical tecniques of Neovagina to treat the vaginal agenesis.
Design
The procedures was performed on Thiel-embalmed cadavers, which allowed the vaginal approach and abdominal cavity pneumoinsufflation and more exact reproduction of the surgical technique, by both vaginal and laparoscopic approaches, in the dissection room at the School of Medicine of our school of Medicine. Previously we made a "feminization" of male cadavers. To do this, the penis was removed together with the testicles and the lips reconstructed with the skin of the penis and scrotum. The space between the base of the scrotum and the anus was exposed to perform the "neovaginas". Four surgical tecniques of Neovaginas were done: vulvoperineal pediculated Flap, Modified Mc Indoe using Paciena prosthesis, Vechietti  and Davidov . Both external camera and  laparoscopic vision were used during the execution of these procedures at the dissection room in "feminized" male cadavers.
To measure the usefulness of this teaching model, we designed a course with specialists in this tecniques to train the surgical steps of the differents surgical procedures. We performed recordings of four  surgical procedures to performe neovaginas (Modified Mc Indoe, Vechietti, Davidov and vulvoperineal pediculated Flaps) with an external camera for vaginal procedures and laparoscopic vision during the execution of laparoscopic procedure, allowing the visualization of anatomical elements. Afterward, a final video (video 1) was made showing the four surgical tecniques for neovaginas. Finally, we explored the opinions of our students and professors in relation to their experiences with this surgical training models.
Results
All the tecniques could be done and recorded without problems.  Most participants agreed that this anatomical model was useful for learning these surgical techniques because they had learned details of the surgical anatomy of these  procedures .
Conclusion
The training in the anatomical model is useful to learn different surgical techniques of Neovaginas.
References
  1. Herlin M, Bjørn AM, Rasmussen M, et al. Prevalence and patient characteristics of Mayer-Rokitansky-Küster-Hauser syndrome: a nationwide registry-based study. Hum Reprod 2016; 31:2384
  2. Wenzl R. Creation of a neovagina: what should our focus be when choosing the "right" operative technique? Fertil Steril. 2017;108(2):242.
Disclosures
Funding Non applicable Clinical Trial No Subjects None
16/06/2024 08:04:22