Laparoscopic Davydov Neovagina Creation in Mayer-Rokitansky-Küster-Hauser Syndrome with Pancake Kidney and a Solitary Ureter Using Dual Indocyanine Green Fluorescence Guidance.

STUDY

OBJECTIVE

To demonstrate a novel dual indocyanine green (ICG) fluorescence-guided laparoscopic Davydov procedure for neovagina creation in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and a pancake kidney with a solitary ureter.

DESIGN

Video article demonstrating a surgical technique.

SETTING

Tertiary referral center.

INTERVENTIONS: A 24-year-old woman with MRKH syndrome and a right-sided pancake kidney with a single ureter presented for definitive surgical management. Total laparoscopic Davydov neovagina creation was performed with dual fluorescence guidance. Prophylactic intravenous cefazolin (2 g) was administered at induction in accordance with institutional guidelines. An ICG-soaked rectal pad was positioned to delineate the rectal boundary during rectovaginal tunnel development under near-infrared imaging. Cystoscopy confirmed solitary ureteral anatomy, followed by selective ureteral catheterization and intraluminal ICG instillation to enable continuous real-time visualization during peritoneal mobilization and suturing. The neovaginal pouch was constructed using mobilized peritoneum circumferentially sutured to the introitus with extracorporeal knot-tying, followed by standardized postoperative stenting and dilation.

CONCLUSION

Dual-structure ICG fluorescence guidance represents an innovative and reproducible adjunct for laparoscopic Davydov neovagina creation. Simultaneous visualization of the rectum and a solitary ureter in the setting of complex renal fusion anomalies enhances anatomic precision and may improve surgical safety during technically demanding MRKH reconstructions.