McIndoe Technique for the Creation of a Neovagina in a Case of Mayer–Rokitansky–Küster–Hauser Syndrome

INTRODUCTION: Mayer–Rokintasky–Küster–Hauser (MRKH) syndrome is a congenital disorder characterized by aplasia or agenesis of the uterus and upper vagina in females with a normal karyotype. Patients with MRKH syndrome have normal-appearing external genitalia and normal secondary sex characteristics, and a shallow vaginal pouch or dimple, an absent uterus, cervix, and upper vagina, but present ovaries and distal fallopian tubes. It occurs in 1 in 4000 to 5000 live female births. These patients often present with primary amenorrhea.1,2 Treatment for patients interested in sexual intercourse entails the creation of a neovagina using serial dilation or surgical construction. Uterus transplantation is an emerging intervention for patients desiring childbearing. Techniques to create the neovagina the McIndoe procedure (utilizing a vaginal mold with skin graft), the Davydov procedure (which uses the peritoneum to create the vaginal canal), Vecchietti procedure (in which an installed traction device causes gradual dilation of the vaginal canal by placing tension on an acrylic bead at the vaginal dimple), and sigmoid colon vaginoplasty (in which a segment of the sigmoid colon is mobilized and fixated to the dissected neovaginal space). These techniques yield comparable vaginal length of 7–8 cm with similar postoperative outcomes, with no technique being superior. We present the case of a 19-year-old with Mayer–Rokitansky–Küster–Hauser syndrome desiring a surgical neovagina via the McIndoe procedure. OBJECTIVE: Our objective is to present an educational surgical video demonstrating the staged surgical construction of a neovagina utilizing the McIndoe procedure. A split-thickness skin graft for the vaginal canal was harvested from the abdomen. METHODS: An educational surgical video was created demonstrating the key steps of the McIndoe procedure to create a neovagina in a patient with MRKH syndrome. A multidisciplinary team of urogynecology and plastic surgery planned the procedure. Preoperative MRI confirmed the absence of extragenital abnormalities. Key steps demonstrated include: dissection of the vaginal dimple, skin graft harvest and preparation of the vaginal mold, securing hemostasis of the neovaginal dissection, placement and securing of the vaginal mold with graft, and final removal of the mold. CapCut was used to edit the video. Informed consent for video and photography was obtained, and all patient identifiers were removed. RESULTS: Our video outlines key reproducible steps of the McIndoe technique to create a surgical neovagina. The patient successfully underwent this stepwise procedure without complications. The final neovaginal length was 11 cm. She was discharged home from the hospital and began vaginal dilation 1 week later to maintain patency of the neovagina. CONCLUSIONS: This video demonstrates the successful creation of a neovagina using the McIndoe procedure. Careful attention to adequate hemostasis remains a point of emphasis for proper healing of the graft postoperatively. Patient adherence to postoperative vaginal dilation is tantamount to long-term success.