Creation of a Neovagina: A Modified Davydov Approach

401 Views | Sep 27, 2019

Authors: Ari Sanders, Sari Kives, Lisa Allen

Affliations: University of Toronto

This video presents a stepwise approach to the creation of a neovagina through a modified laparoscopic Davydov approach. This is most commonly performed for vaginal agenesis. First line treatment is self-dilation with multidisciplinary support. When first line treatment fails, a surgical approach to neovaginal creation is the Davydov procedure. It is comprised of five steps: 1) define the anatomy (+ salpingectomy), 2) create the neovaginal space, 3) line the neovagina with peritoneum, 4) dissect the pelvic sidewall, and 5) suture the neovagina over the stent.The modified laparoscopic approach involves round ligament preservation (instead of transection) for added vaginal support. It also involves transection of the utero-ovarian ligaments (instead of preservation) to keep ovaries in their anatomical location. More extensive pelvic sidewall dissection helps avoid tension on sidewall structures.The Davydov procedure has high rates of sexual satisfaction and should be considered for the surgical creation of a neovagina.