OBJECTIVE To introduce the minimally invasive Vecchietti procedure based on single-port laparoscopy with self-made surgical instruments for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). DESIGN Surgical video article. The approval of the Institutional Review Board and written consent from the patient were obtained. SETTING University hospital. PATIENT(S) A 22-year-old woman presented with primary amenorrhea and inability to participate in penetrative sexual intercourse. A gynecological examination revealed a phenotypically normal vulva and absence of the vagina. A normal 46,XX karyotype was expressed. Magnetic resonance imaging and ultrasonic imaging of the abdomen and pelvis indicated that the ovaries were normal in size and there was vaginal agenesis with rudimentary uterus. No other congenital malformations were present. INTERVENTION(S) The modified Vecchietti procedure involved a transvaginal operation and laparoscopic surgery. The epidural catheter was stretched and made into two wires that were tucked into the core of the Veress needle and then folded into four strings for perineal puncture. A transverse incision of about 3 cm was made in the center of the navel, layer by layer into the abdomen, and placed in a self-made single port (made of a small wound protector and an 8-inch glove), introducing the laparoscope. Under laparoscopic surveillance, the Veress needle was inserted through the vesicorectal space guided by the index finger, which was placed in the rectum. The epidural catheter was pumped from the core into the abdominal cavity under laparoscopy. Subsequently, cystoscopy was performed to ensure that no bladder perforation occurred during the needle insertion. The ball-shaped acrylic device and the two rubber stoppers were attached to the epidural catheter of the vulva. An epidural puncture needle with wire perforated the peritoneum through McBurney's point and the opposite McBurney's point, pulling the epidural catheter out of the abdominal cavity. The epidural catheter was curled around the gauze rolls until the ball-shaped device could be accommodated into the newly created cavity at a sufficient depth. After the surgery, the top of neovagina was lifted about 1 cm every day by tightening gauze rolls to increase the traction, until a neovagina 9 cm long was achieved. MAIN OUTCOME MEASURE(S) The clinical and anatomical data such as the operative time, intraoperative bleeding, duration of hospitalization, and measurement of the final length of the newly created canal 30 days after surgery and 3 months after surgery. RESULT(S) The operative time was 30 minutes, and the intraoperative blood loss was 10 mL. The duration of hospitalization was 10 days. Before discharge, the vaginal depth was 9 cm at 5 days after the surgery, and the self-made traction system was removed. A plastic mold was then inserted using povidone-iodine. The vaginal dilator had to be worn day and night. The patient was advised to sit at the corner of a hard bed or chair from time to time to enhance the dilated effect of the vaginal mold. Three months after the surgery, it could be worn each night until regular sexual intercourse was initiated. The canal length 30 days and 3 months after the surgery was nearly 9 cm. CONCLUSION(S) The modified Vecchietti vaginoplasty is a simple, safe, cost-effective, and minimally invasive procedure, offering an anatomic and functional neovagina for MRKH patients.

中文翻译：

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使用自制单孔腹腔镜术治疗 Mayer-Rokitansky-Küster-Hauser 综合征的改良 Vecchietti 阴道成形术

目的介绍基于单孔腹腔镜和自制手术器械的微创Vecchietti手术治疗Mayer-Rokitansky-Küster-Hauser综合征（MRKH）。设计外科视频文章。获得了机构审查委员会的批准和患者的书面同意。设置大学医院。患者 一名 22 岁女性因原发性闭经而无法参与插入式性交。妇科检查显示外阴表型正常且无阴道。表达了正常的 46,XX 核型。腹部和骨盆磁共振成像和超声成像显示卵巢大小正常，阴道发育不全，子宫发育不良。无其他先天性畸形。干预措施 改良的 Vecchietti 手术包括经阴道手术和腹腔镜手术。硬膜外导管被拉伸并制成两根线，塞入气腹针的核心，然后折叠成四根线用于会阴穿刺。在肚脐中央做一个约3cm的横切口，逐层切入腹部，放入自制的单口（小伤口保护套和8寸手套），引入腹腔镜. 在腹腔镜监视下，将 Veress 针插入由食指引导的膀胱直肠空间，食指放置在直肠中。在腹腔镜下，硬膜外导管从核心泵入腹腔。随后，进行膀胱镜检查以确保在针插入过程中没有发生膀胱穿孔。球状亚克力装置和两个橡胶塞与外阴硬膜外导管相连。一根带金属丝的硬膜外穿刺针通过 McBurney 点和对面的 McBurney 点刺穿腹膜，将硬膜外导管拉出腹腔。硬膜外导管围绕纱布卷卷曲，直到球形装置可以以足够的深度容纳在新创建的腔中。手术结束后，每天通过绷紧纱布卷以增加牵引力将新阴道顶部抬起约1厘米，直至达到9厘米长的新阴道。主要观察指标：手术时间、术中出血、住院时间，并在手术后 30 天和手术后 3 个月测量新创建的根管的最终长度。结果 手术时间30分钟，术中失血10毫升。住院时间为10天。出院前，术后5天阴道深度为9cm，取出自制牵引系统。然后使用聚维酮碘插入塑料模具。阴道扩张器必须日夜佩戴。建议患者不时坐在硬床或椅子的角落，以增强阴道霉菌的扩张效果。手术后三个月，可以每晚佩戴，直到开始有规律的性交。手术后30天和3个月的根管长度接近9厘米。