Hymen conservative techniques for vaginal surgery - a practical approach

Zaki Sleiman 1, Amal Ayed 2, Costas Christoforou 3, Marco Noventa 4, Amerigo Vitagliano 4, Antonio Simone Laganà 5, Giovanni Buzzaccarini 4

Affiliations

01 March 2022

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doi: 10.5114/pm.2022.113556

Abstract

Vaginal approach remains one of the safest and easiest surgical procedures to treat many gynaecological pathologies such as cervico-vaginal fibroids or vaginal septum. These classical procedures are, however, hindered by the disruption of the integrity of the hymen, an issue that remains controversial if not unfavourable in certain conservative geographical areas such as the Middle East. Herein, we describe 3 alternative surgical laparoscopic techniques to deal with the issue of hymen conservation. In the first 2 cases we suggest a laparoscopic approach through an anterior or a posterior colpotomy to treat large cervico-vaginal fibroids. In the third case, we propose a laparoscopic technique for the resection of a vaginal septum in a young girl with obstructed hemivagina and ipsilateral renal agenesis syndrome.

Keywords: colpotomy; hymen preservation; mini-laparotomy; vaginal fibroids.

Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1 After having performed the posterior colpotomy, the pedunculated fibroid was identified

Fig. 1 After having performed the posterior colpotomy, the pedunculated fibroid was identified

Fig. 2 The posterior colporrhaphy has been performed and the fibroid is yet to be extracted

Fig. 2 The posterior colporrhaphy has been performed and the fibroid is yet to be extracted

Fig. 3 The picture depicts the frozen pelvis and the difficult access for a posterior colpotomy

Fig. 3 The picture depicts the frozen pelvis and the difficult access for a posterior colpotomy

Fig. 4 The picture shows the anterior colpotomy and the extraction of the fibroid

Fig. 4 The picture shows the anterior colpotomy and the extraction of the fibroid

Fig. 5 The atraumatic graspers are introduced through the posterior colpotomy in a patient with obstructed hemivagina and ipsilateral renal agenesis syndrome

Fig. 5 The atraumatic graspers are introduced through the posterior colpotomy in a patient with obstructed hemivagina and ipsilateral renal agenesis syndrome

Fig. 6 Laparoscopic graspers are pushing the vaginal septum outside the hymenal ring (left side), followed by excision of the septum using the grasper as a landmark (right side)

Fig. 6 Laparoscopic graspers are pushing the vaginal septum outside the hymenal ring (left side), followed by excision of the septum using the grasper as a landmark (right side)

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KMEL References

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References

  1.  
    1. Matsuoka S, Kikuchi I, Kitade M, et al. . Strategy for Laparoscopic cervical myomectomy. J Minim Invasive Gynecol 2010; 17:301-305. - PubMed
  2.  
    1. Tug N, Sargın MA, Çelik A, Alp T, Yenidede I. Treatment of virgin OHVIRA Syndrome with haematometrocolpos by complete incision of vaginal septum without hymenotomy. J Clin Diagn Res 2015; 9: QD15-16. - PMC - PubMed
  3.  
    1. Bennett HG, Ehrlich MM. Myoma of the vagina. Am J Obstet Gynecol 1941; 42: 314-320.
  4.  
    1. Young SB, Rose PG, Reuter KL. Vaginal fibromyomata: two cases with preoperative assessment, resection, and reconstruction. Obstet Gynecol 1991; 78: 972-974. - PubMed
  5.  
    1. Awwad J, Nassar A, Usta I, Shaya M, Younes Z, Ghazeeri G. Attitudes of Lebanese university students towards surgical hymen reconstruction. Arch Sex Behav 2013; 42: 1627-1635. - PubMed
  6.  
    1. Wehbe GS, Doughane M, Bitar R, Sleiman Z. Laparoscopic posterior Colpotomy for a Cervico-vaginal Leiomyoma: hymen conservative technique. Facts Views Vis Obgyn 2016; 8: 169-171. - PMC - PubMed
  7.  
    1. Sleiman Z, Wehbe GS, Rassy EE, et al. . A novel surgical intervention for an uncommon entity: laparoscopy-assisted resection of a vaginal septum in obstructed hemivagina and ipsilateral renal anomaly syndrome. J Laparoendosc Adv Surg Tech A 2019; 29: 714-716. - PubMed
  8.  
    1. Brooks GG, Stage AH. The surgical management of prolapsed pedunculated submucous leiomyomas. Surg Gynecol Obstet 1975; 141: 397-398. - PubMed
  9.  
    1. Golan A, Zachalka N, Lurie S, Sagiv R, Glezerman M. Vaginal removal of prolapsed pedunculated submucous myoma: A short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet 2005; 271: 11-13. - PubMed
  10.  
    1. Cohen LS, Valle RF. Role of vaginal sonography and hysterosonography in the endoscopic treatment of uterine myomas. Fertil Steril 2000; 73: 197-204. - PubMed
  11.  
    1. Kaivanara M. Virginity dilemma: re-creating virginity through hymenoplasty in Iran. Cult Heal Sex 2016; 18: 71-83. - PubMed
  12.  
    1. Murakami T, Tamura M, Ozawa Y, Suzuki H, Terada Y, Okamura K. Safe techniques in surgery for hysteroscopic myomectomy. J Obstet Gynaecol Res; 2005; 31: 216-223. - PubMed
  13.  
    1. Küçük T. When virginity does matter: rigid hysteroscopy for diagnostic and operative vaginoscopy-A series of 26 cases. J Minim Invasive Gynecol 2007; 14: 651-653. - PubMed
  14.  
    1. Yalçin I, Pabuçcu E, Kahraman K, Sönmezer M. Mini-laparotomic colpotomy for a cervicovaginal leiomyoma: preservation of hymenal integrity. Int J Reprod Biomed 2016; 14: 217-220. - PMC - PubMed
  15.  
    1. Naem A, Shamandi A, Al-Kurdy B. A rare form of Mayer-Rokitansky-Küster-Hauser Syndrome associated with ovarian endometrioma: a case report. J Surg Case Rep 2020; 2020: rjaa393. - PMC - PubMed
  16.  
    1. Buzzaccarini G, Stabile G, Török P, et al. . Surgical approach for enlarged uteri: further tailoring of vNOTES hysterectomy. J Invest Surg 2021: 1-2. - PubMed
  17.  
    1. Buzzaccarini G, Noventa M, d’Alterio MN, et al. . vNOTES Hysterectomy: can it be considered the optimal approach for obese patients? J Invest Surg 2021; 1-2. - PubMed

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