Is robotic-assisted vaginectomy a better choice in vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery? Vaginectomy has been shown to be effective for select patients with vaginal high-grade squamous intraepithelial lesions (HSIL) and is favored by gynecologists, while there are few reports on the robotic-assisted laparoscopic vaginectomy (RALV). The aim of this study was to evaluate the safety and treatment outcomes between RALV and the conventional laparoscopic vaginectomy (CLV) for patients with vaginal HSIL. This retrospective cohort study was conducted in 109 patients with vaginal HSIL who underwent either RALV (RALV group) or CLV (CLV group) from December 2013 to May 2022. The operative data, homogeneous HPV infection regression rate and vaginal HSIL
Omission of Pelvic Examination Before Gender-Affirming Hysterectomy and Vaginectomy. Surgeons may be performing pelvic examinations on transgender patients before gender-affirming pelvic surgery (hysterectomy and vaginectomy) without a clinically significant indication. A retrospective cohort study was conducted at a single-institution academic referral center comparing 30-day perioperative outcomes of all 62 gender-affirming pelvic surgeries, including hysterectomy alone, hysterectomy with vaginectomy, and vaginectomy alone, between April 2018 and March 2022. More than half (53.2%, n=33) of the 62 patients did not have an in-office, preoperative, internal pelvic examination within 1 year of gender-affirming surgery. There were no significant differences in patient characteristics nor 30
Use of a Split Pedicled Gracilis Muscle Flap in Robotically Assisted Vaginectomy and Urethral Lengthening for Phalloplasty: A Novel Technique for Female-to-Male Genital Reconstruction. The authors describe the technique of robotic vaginectomy, anterior vaginal flap urethroplasty, and use of a longitudinally split pedicled gracilis muscle flap to recreate the bulbar urethra and help fill the vaginal defect in female-to-male gender-affirming phalloplasty. Vaginectomy is performed by means of the robotically assisted laparoscopic transabdominal approach. Concurrently, gracilis muscle is harvested and passed through a tunnel between the groin and the vaginal cavity. It is then split longitudinally, and the inferior half is passed into the vaginal cavity; it is inset into the vaginal cavity
Gender-affirming Vaginectomy-Transperineal Approach. Gender-affirming vaginectomy treats gender dysphoria associated with the presence of a vagina in transgender males. Prior reported approaches include transperineal vaginectomy, mucosal fulguration, and robotic-assisted. We present key steps in transperineal gender-affirming vaginectomy in a 39-year-old transgender male. Informed consent then proceeded with a second-stage phalloplasty that included urethral lengthening and scrotoplasty. The demonstrated procedure took 110 minutes and estimated blood loss was 75 mL. In our published series of 40 vaginectomies for 27 phalloplasties and 13 metoidioplasties, median operative time was 135 minutes and median estimated blood loss was 250cc. No complications related to the vaginectomy, including
Vaginectomy and Buccal Mucosa Vaginoplasty as Local Therapy for Pediatric Vaginal Rhabdomyosarcoma. We report a case of vaginal rhabdomyosarcoma where vaginectomy with buccal mucosa vaginoplasty was performed to avoid radiation therapy to the young pelvis. The patient presented at 30 months with an exophytic vaginal mass, found to be botryoid rhabdomyosarcoma. After receiving neoadjuvant
Phalloplasty with Urethral Lengthening: Addition of a Vascularized Bulbospongiosus Flap from Vaginectomy Reduces Postoperative Urethral Complications. Phalloplasty with urethral lengthening is the procedure of choice for female-to-male transgender patients who desire an aesthetic phallus and standing micturition, but is associated with complications, including urethral stricture and fistula formation. Horizontal urethra construction can be accomplished with labia minora flaps covered with additional vascularized layers of vestibular tissue when vaginectomy is performed concomitantly with phalloplasty. However, vaginectomy is not a requisite step in phalloplasty, and some individuals may choose to retain their vagina. In these cases, extra layers of vascularized vestibular tissue are not used
Total vaginectomy for refractory vaginal intraepithelial neoplasia III of the vaginal vault Vaginal intraepithelial neoplasia III, is a relatively rare disease. Consequently standard treatments for this disease were not established until recently. Although several convenient methods, such as laser ablation, 5-fluorouracil topical injection, and radiation therapy, have been applied for treating these lesions, surgical treatments, including vaginectomy, have not yet been attempted, as they would likely be accompanied by technical difficulties and various complications. Herein, we report a case of refractory vaginal intraepithelial neoplasia III in the vaginal vault that was successfully treated with a total vaginectomy.
Long-term survival after anterior pelvic exenteration and total vaginectomy for recurrent endometrial carcinoma with metastatic inguinal nodes at the time of surgery •Pelvic exenteration can be used in patients with multifocal recurrence.•Ability to achieve negative margins remains a necessity for pelvic exenteration.•Individualized treatments are essential for those with recurrent malignancy.
of evidence C3]Treatment options for VaIN include the following:Laser therapy [5] after biopsy to rule out invasive components that could be missed with this treatment approach.Wide local excision with or without skin grafting.[6]Partial or total vaginectomy, with skin grafting for multifocal or extensive disease.[7]Intravaginal chemotherapy with 5% fluorouracil (5-FU) cream. This option may be useful Gynecol 73 (4): 657-60, 1989. [PUBMED Abstract]Cheng D, Ng TY, Ngan HY, et al.: Wide local excision (WLE) for vaginal intraepithelial neoplasia (VAIN). Acta Obstet Gynecol Scand 78 (7): 648-52, 1999. [PUBMED Abstract]Indermaur MD, Martino MA, Fiorica JV, et al.: Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia. Am J Obstet Gynecol 193 (2): 577-80; discussion 580-1, 2005. [PUBMED
with or without salpingo-oophorectomy, reconstruction of the fixed part of the urethra, which can be combined with a metoidioplasty or with a phalloplasty (employing a pedicled or free vascularized flap), vaginectomy, scrotoplasty, and implantation of erection or testicular prostheses * Nongenital, nonbreast surgical interventions: voice surgery (rare), liposuction, lipofilling, pectoral implants vaginectomy and scrotoplasty. Patients who choose urethral lengthening will be able to void when standing if they are close to ideal body weight. If a patient desires scrotoplasty, rotational flaps of the labia majora are used to place the scrotum in an anatomic male position. Implants can be placed approximately 6 months later. Phalloplasty generally takes tissue from a donor site, which is shaped
and upper vaginectomy should be considered [III, B].Radiotherapy can be considered as an alternative modality to surgical treatment, considering the risk-benefit of repeat surgery [IV, C].Management of Patients with ≥ T1b2 Disease, Involved Surgical Margins and/or Residual Tumor (Including LN)For patients with free surgical margins and in the absence of residual tumor on imaging (including non-suspicious
from 13 to 30 years (median 19 years). Patient diagnosis included cloacal anomalies (n = 4), Mayer-Rokitansky-Küster-Hauser syndrome (n = 4), isolated vaginal atresia with or without a transverse vaginal septum (n = 4), and vaginal rhabdomyosarcoma requiring partial vaginectomy (n = 1). Following dissection of the neovaginal space, a silicon mold wrapped with SIS graft was placed with retention
Consortium. We present a case of a 2-year-old with intermediate risk uterine RMS. She was treated with a multimodal regimen including chemotherapy, radiation, and surgery with abdominal hysterectomy, bilateral salpingectomy, oophoropexy, partial proximal vaginectomy, and right extravesical non-refluxing ureteral reimplant to achieve a complete resection.
management included initial tumor debulking and subsequent partial vaginectomy with vaginal reconstruction following chemotherapy. There has been no evidence of disease on surveillance 7 years after diagnosis.
. In the study period, 164 patients underwent peripelvic defect reconstruction. Most had colorectal (57%), anal (17%), or gynecologic malignancies (10%). 83% had prior radiation. 33.3% had Class II or III obesity. The most common resection was open colorectal resection with partial vaginectomy (66%). Pedicled flaps (93%) were frequently used, mainly vertical rectus abdominis muscle (65%) and gracilis (11
radiotherapy•radical surgery consisting of parametrectomy, upper vaginectomy and pelvic lymphadenectomy.If there is gross lymphadenopathy (≥2 cm) demonstrated on radiological examination, an extraperitoneal lymphadenectomy should be performed followed by radiotherapy.Re-operation should not be performed if there is evidence of metastatic disease, or an indication for post-operative radiotherapy on the basis