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Tian Y, Liu Y, Xiao Y, Li Z, Zhang M, Chen L, Li Z, Zhang W, Zhang Z, Kong D, Meng L, Du Y, Zhang J, Gao J, Huang X. Alternative Biological Material for Tissue Engineering of the Vagina: Porcine-Derived Acellular Vaginal Matrix. Tissue Eng Regen Med 2024; 21:277-290. [PMID: 37947984 PMCID: PMC10825107 DOI: 10.1007/s13770-023-00604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a severe congenital disorder characterized by vaginal hypoplasia caused by dysplasia of the Müllerian duct. Patients with MRKH syndrome often require nonsurgical or surgical treatment to achieve satisfactory vaginal length and sexual outcomes. The extracellular matrix has been successfully used for vaginal reconstruction. METHODS In this study, we developed a new biological material derived from porcine vagina (acellular vaginal matrix, AVM) to reconstruct the vagina in Bama miniature pigs. The histological characteristics and efficacy of acellularization of AVM were evaluated, and AVM was subsequently transplanted into Bama miniature pigs to reconstruct the vaginas. RESULTS Macroscopic analysis showed that the neovaginas functioned well in all Bama miniature pigs with AVM implants. Histological analysis and electrophysiological evidence indicated that morphological and functional recovery was restored in normal vaginal tissues. Scanning electron microscopy showed that the neovaginas had mucosal folds characteristics of normal vagina. No significant differences were observed in the expression of CK14, HSP47, and α-actin between the neovaginas and normal vaginal tissues. However, the expression of estrogen receptor (ER) was significantly lower in the neovaginas than in normal vaginal tissues. In addition, AVM promoted the expression of β-catenin, c-Myc, and cyclin D1. These results suggest that AVM might promotes vaginal regeneration by activating the β-catenin/c-Myc/cyclin D1 pathway. CONCLUSION This study reveals that porcine-derived AVM has potential application for vaginal regeneration.
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Affiliation(s)
- Yanpeng Tian
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yibin Liu
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Yanlai Xiao
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Zhongkang Li
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Mingle Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Liang Chen
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Zhen Li
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Wangchao Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Zhiqiang Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Desheng Kong
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Li Meng
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Yanfang Du
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Jingkun Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Jingui Gao
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Xianghua Huang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, People's Republic of China.
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Wang J, Wei G, Yi Z, Liu M, Wu W, Hu W, Zheng J, Yao X, Li Y. Total laparoscopic sigmoid vaginoplasty: a novel therapeutic approach. ANZ J Surg 2020; 91:E20-E24. [PMID: 32338816 DOI: 10.1111/ans.15786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to evaluate the technical feasibility and outcomes of total laparoscopic sigmoid vaginoplasty (TLSV) in women with congenital absence of the vagina. METHODS We investigated 10 women with congenital absence of the vagina, who underwent TLSV at Guangdong Provincial People's Hospital between April 2013 and July 2016. RESULTS All 10 women were unmarried, the mean age was 22.8 (range 17-33) years, mean estimated blood loss was 149.2 ± 54.8 (60-170) mL, mean operative time was 108.4 ± 52.6 (130-210) min, mean post-operative hospital stay was 8.0 ± 2.8 (6-12) days and the mean neovaginal length was 13.4 ± 3.0 (12-16) cm. Eight of the 10 women were heterosexually active. Trocar port site infection and neovaginal stenosis occurred 3 months after TLSV in one patient; a vaginal mould was used to relieve the stenosis. CONCLUSION TLSV is an optimal minimally invasive procedure to treat women with congenital absence of the vagina and is associated with rapid recovery and acceptable cosmetic effects.
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Affiliation(s)
- Junjiang Wang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gengzhou Wei
- Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiyong Yi
- Department of General Surgery, Eighth People's Hospital of Guangzhou, Guangzhou, China
| | - Mubiao Liu
- Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wulin Wu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weixian Hu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Zheng
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueqing Yao
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Li
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhang W, Li C, Cheng W, Li T, Gao H, Zhang H, Xu X. Application of mesocolon rotation and reverse puncture in total laparoscopic sigmoid vaginoplasty. Exp Ther Med 2019; 18:3191-3196. [PMID: 31555391 DOI: 10.3892/etm.2019.7920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/31/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to explore the clinical efficacy of mesocolon rotation and reverse puncture in total laparoscopic sigmoid vaginoplasty (LSV). The clinical data of 11 patients (unmarried, n=4; married, n=7) with congenital absence of a vagina who underwent treatment of total laparoscopic sigmoid vaginoplasty at the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China) between March 2013 and March 2016 were retrospectively analyzed. In all patients, the surgical method included sigmoid mesocolon rotation and reverse puncture. The vaginal depth, the first sexual intercourse time and female sexual function indexes were recorded. The average operation time was 187±19 min, the average intra-operative blood loss was 132±24 ml, the time to the first meal after surgery was 4.3±1.1 days, the average post-operative hospital stay was 7.5±1.2 days, the post-operative short-term complication rate was 36.3% and the time to the first sexual intercourse was 3.0±0.3 months. The post-operative follow-up results indicated that the anatomical standard was reached in all of the 11 patients. Among the seven married patients, five patients were satisfied with their sex lives after the operation. In terms of psychosexual desire, only one married patient felt no sexual arousal. The other married patients had good sexual relations, function and satisfaction. In conclusion, the application of mesocolon rotation and reverse puncture in total LSV is safe and feasible.
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Affiliation(s)
- Wenbin Zhang
- Department of Gastrointestinal Tumors, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Chunxing Li
- Department of Gastrointestinal Tumors, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Wenjie Cheng
- Department of General Surgery, Luopu County People's Hospital, Hotan, Xinjiang 848000, P.R. China
| | - Tao Li
- Department of Gastrointestinal Tumors, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Hua Gao
- Department of Gastrointestinal Tumors, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Huihui Zhang
- The 12th Division Hospital of Xinjiang Production and Construction Corps, Urumqi, Xinjiang 830013, P.R. China
| | - Xincai Xu
- Department of Gastrointestinal Tumors, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
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Sexual satisfaction in patients with Mayer-Rokitansky-Küster-Hauser syndrome after surgical and non-surgical techniques: a systematic review. Int Urogynecol J 2019; 30:353-362. [DOI: 10.1007/s00192-018-3854-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022]
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Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4907208. [PMID: 29862275 PMCID: PMC5971241 DOI: 10.1155/2018/4907208] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
Abstract
Background Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques. Methods Records were retrospectively reviewed for all transwomen undergoing primary sigmoid vaginoplasty with the University of Miami Gender Reassignment service between 2014 and 2017. Results Average neovaginal depth was 13.9 +/− 2.0 centimeters in 12 patients. 67% were without complications, and all maintained tissue conducive to sexual activity. No incidences of bowel injury, anastomotic leak, sigmoid necrosis, prolapse, diversion neovaginitis, dyspareunia, or excessive secretions had occurred at last follow-up. Conclusions Sigmoid vaginoplasty is a reliable technique for achieving a satisfactory vaginal depth that is sexually functional. Using a collaborative approach, it is now our standard of care to offer this surgery to transwomen with phallus length less than 11.4 centimeters.
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Far SS, Miraj S. Single-incision laparoscopy surgery: a systematic review. Electron Physician 2016; 8:3088-3095. [PMID: 27957308 PMCID: PMC5133033 DOI: 10.19082/3088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
Background Laparoscopic surgery is a modern surgical technique in which operations are performed far from their location through small incisions elsewhere in the body. Objective This systematic review is aimed to overview single-incision laparoscopy surgery. Methods This systematic review was carried out by searching studies in PubMed, Medline, Web of Science, and IranMedex databases. The initial search strategy identified about 87 references. In this study, 54 studies were accepted for further screening and met all our inclusion criteria [in English, full text, therapeutic effects of single-incision laparoscopy surgery and dated mainly from the year 1990 to 2016]. The search terms were “single-incision,” “surgery,” and “laparoscopy.” Results Single-incision laparoscopy surgery is widely used for surgical operations in cholecystectomy, sleeve gastrectomy, cholecystoduodenostomy, hepatobiliary disease, colon cancer, obesity, appendectomy, liver surgery, rectosigmoid cancer, vaginal hysterectomy, vaginoplasty, colorectal lung metastases, pyloroplasty, endoscopic surgery, hernia repair, nephrectomy, rectal cancer, colectomy and uterus-preserving repair, bile duct exploration, ileo-ileal resection, lymphadenectomy, incarcerated inguinal hernia, anastomosis, congenital anomaly, colectomy for cancer. Conclusion Based on the findings, single-incision laparoscopy surgery is a scarless surgery with minimal access. Although it possesses lots of benefits, including less incisional pain and scars, cosmesis, and the ability to convert to standard multiport laparoscopic surgery, it has some disadvantages, for example, less freedom of movement, fewer number of ports that can be used, and the proximity of the instruments to each other during the operation.
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Affiliation(s)
- Sasan Saeed Far
- MD of General Surgery, Instructor, Molecular and Cellular Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Sepide Miraj
- M.D., Gynecologist, Fellowship of Infertility, Assistant Professor, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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