- C William Helm, MD
C William Helm, MD
- Consultant Gynaecological Oncologist
- Northern Gynaecological Oncology Centre
- Queen Elizabeth Hospital
Partial and total vaginectomy refer to procedures in which the vaginal epithelium is removed without disruption of the adjacent tissues of the paracolpium. The most common indication for these procedures is treatment of vaginal intraepithelial neoplasia. Rarely, chronic benign conditions such as lichen planus may be severe enough to warrant vaginectomy. Partial vaginectomy may also be utilized to biopsy large vaginal lesions of unknown etiology. Radical vaginectomy is performed for pelvic malignancy involving or encroaching upon the vagina. It is rarely indicated. More commonly, at the time of radical hysterectomy for early cervix cancer or endometrial cancer involving the cervix, the upper third (2 to 3 cm) of the vagina is removed with some adjacent paracolpium.
PARTIAL OR TOTAL VAGINECTOMY
Preoperative preparation — The procedure should be clearly explained to the patient and her partner, particularly with regard to complications. The issue of vaginal reconstruction should also be raised, depending upon the amount of vagina to be removed. Thorough bowel preparation is mandatory for more extensive vaginal surgery in case of injury to the rectum or anus. (See "Overview of preoperative evaluation and preparation for gynecologic surgery", section on 'Bowel preparation'.)
Operative procedure — General, epidural, or spinal anesthesia is administered. The patient may be placed in lithotomy position if the only approach is via the perineum and vaginal reconstruction is not planned. For all other procedures, the patient is placed in a modified frog leg position in Allen stirrups.
A total abdominal or vaginal hysterectomy is usually performed concurrently in women with an intact uterus who require total vaginectomy or upper partial vaginectomy. If two surgeons are available, a combined abdominoperineal approach facilitates the surgery. For women who have previously undergone hysterectomy, it is possible to perform total vaginectomy entirely from below. Great care must be taken to include all vaginal skin in the angles and vault of the vagina.
- Choi YJ, Hur SY, Park JS, Lee KH. Laparoscopic upper vaginectomy for post-hysterectomy high risk vaginal intraepithelial neoplasia and superficially invasive vaginal carcinoma. World J Surg Oncol 2013; 11:126.
- Kavallaris A, Hornemann A, Chalvatzas N, et al. Laparoscopic nerve-sparing radical hysterectomy: description of the technique and patients' outcome. Gynecol Oncol 2010; 119:198.
- Pomel C, Rouzier R, Pocard M, et al. Laparoscopic total pelvic exenteration for cervical cancer relapse. Gynecol Oncol 2003; 91:616.
- Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol 2010; 11:292.
- Pusic AL, Mehrara BJ. Vaginal reconstruction: an algorithm approach to defect classification and flap reconstruction. J Surg Oncol 2006; 94:515.
- Hoffman MS, Cardosi RJ, Lockhart J, et al. Vaginectomy with pelvic herniorrhaphy for prolapse. Am J Obstet Gynecol 2003; 189:364.
- Wee JT, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report. Plast Reconstr Surg 1989; 83:701.
- Stany MP, Winter WE 3rd, Elkas JC, Rose GS. The use of acellular dermal graft for vulvovaginal reconstruction in a patient with lichen planus. Obstet Gynecol 2005; 105:1268.
- Copeland LJ, Hancock KC, Gershenson DM, et al. Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration. Am J Obstet Gynecol 1989; 160:1095.
- Tobin GR, Pursell SH, Day TG Jr. Refinements in vaginal reconstruction using rectus abdominis flaps. Clin Plast Surg 1990; 17:705.
- Soper JT, Secord AA, Havrilesky LJ, et al. Comparison of gracilis and rectus abdominis myocutaneous flap neovaginal reconstruction performed during radical pelvic surgery: flap-specific morbidity. Int J Gynecol Cancer 2007; 17:298.