Retrospective comparative cohort study of neovagina creation by modified Vecchietti-laparoendoscopic single-site surgery for Mayer-Rokitansky-Küster-Hauser syndrome

BACKGROUND: Although traditional multi-incision laparoscopic surgery is minimally invasive, it can still leave surgical scars on the lower abdomen. This study reports a modified Vecchietti-laparoendoscopic single-site (MVLESS) procedure using self-made instruments to create a neovagina for Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and to determine the efficacy and safety. METHODS: We conducted a retrospective comparative cohort study analysis of the clinical data from MRKHS patients treated in the Department of Difficult Gynecological Disease at Xi’an People’s Hospital between January 2010 and December 2020.Women who were diagnosed with MRKHS and underwent a MVLESS procedure using self-made instruments to create a new vagina were selected as the study group (n=14). Patients who underwent a traditional multi-incision Vecchietti (TMV) procedure were selected as the control group (n=22). All participants in both groups were required to complete a Female Sexual Function Index (FSFI) and Female Genital Self-Image Scale (FGSIS) questionnaire. RESULTS: All patients in the study group were diagnosed with type I MRKHS and 3 (21.43%) were sexually active. Twenty-one patients in the control group were diagnosed with type I (95.45%) MRKHS, 1 (4.55%) had type II MRKHS (absent left kidney), and 6 (27.27%) were sexually active. The neovaginas in both groups were wide with good elasticity, softness, smoothness, and lubrication. There were no significant differences in operative time (37±6 vs. 39±4 minutes, P=0.98), intraoperative bleeding (28.32±9.82 vs. 29.45±3.84 mL, P=0.86), postoperative anal exsufflation time (18±4 vs. 20±4 hours, P=0.82), and postoperative hospital stay (7±2 vs. 8±2 days, P=0.84) between the MVLESS and TMV groups. The FSFI and FGSIS scores in both groups showed participants had a good quality of sexual life based on the 12-month follow-up data; however, sexual function was significantly better in the study group than in the control group [lubrication (4.72±0.86 vs. 4.64±1.01, P=0.023), visual analog scale (VAS; 4.26±0.52 vs. 4.45±0.39, P=0.041), total FSFI scores (30.21±4.32 vs. 28.42±2.21, P=0.048), and FGSIS score (23.21±1.98 vs. 22.14±2.04, P=0.012)]. CONCLUSIONS: The MVLESS procedure is a simple, safe, and minimally invasive procedure that provides an anatomical and functional neovagina for MRKHS patients. It is an alternative method for creating a neovagina to achieve satisfactory anatomic and sexual function. However, it is still a difficult problem to solve fertility problems for patients with congenital absence of vagina.