Methods
Padua University, Italy, Ethics Committees approved the clinical study’s vaginal outlectomy protocol and informed consent (No. 23445/2019). The Warsaw Medical University Bioethics Committee, Poland, approved the experimental anatomical dissections of the urogenital tract on fresh human female adult cadavers and practiced the newly developed vaginal outlectomy procedure ( No. AKBE 146/12). The anatomical dissections were conducted at the Forensic Medicine Department, and the author executed all the anatomical macro and micro (3.5 – 4.00 magnifying loupe) dissections. Additionally, he practiced a new vaginal outlectomy surgical intervention. The anatomical dissections were conducted at the Forensic Medicine Department, and the author executed all the anatomical macro and micro (3.5 – 4.0 magnifying loupe) dissections. Additionally, the author practiced a new vaginal outlectomy surgical intervention on female corps.
Eighteen pregnant at term women were recruited, and the case series study was conducted on this cohort subjects. These patients underwent a clinical assessment in the supine position with the legs on stirrups. The posterior-distal vaginal wall, posterior perineum, and anal external and internal sphincters were evaluated by visual inspections and digital vaginal and anal examination.
The most stretch vaginal outlet resistant force on the fetal head at delivery was used as a reference point to determine the small V-shape vaginal outletlectomy excision location. After outlectorrhaphy (V-shape excision’s defect repairs), blood loss was subjectively assessed by inspecting the excision site, posterior perineum skin blood smear, and clots.
On the first postpartum day, perineal pain perception levels and at three months postpartum, superficial dyspareunia perception levels were measured using a validated Numeric Rating Scale (NRS).10 an 11-point scale for patients self-reporting that is based on daily living activities and pain raging 1) no pain - 0; 2) mild pain from 1-3 on the NRS scale (nagging, annoying, and little interfering with activities of daily living; 2) moderate pain from 4-6 on the NRS scale (interferes significantly with activities of daily living); 3) severe pain from 7-10 on the NRS (disabling; unable to perform daily living activities).
Generally accepted indications for traditional episiotomy, Tabl.1, were closely followed and used in the selection process for the present study. This study included singleton fetuses pregnancy in the vertex presentation with occiput anterior and sonographically estimated fetal weight between 2,629gm and 3,999 gm.
Patients who presented with prior episiotomy scar or perineal obstetric - gynecologic surgery or perineal trauma were excluded from the current study. Furthermore, those subjects who reported superficial dyspareunia, dyschezia, or pain in the crotch were also excluded from this study. In addition, abnormal fetal presentations (malpresentation) and breech presentation were excluded from the present study.
The goal of the current research was to develop a new episiotomy procedure that would exclude the posterior perineum. Ostrzenski’s vaginal outlectomy first step is identifying the “belt-like” structure embracing the fetal head circumference; a midwife or obstetrician numbs the area between 7 and 8 o’clock with plain lidocaine 1%. At the I-stage of parturition, the lidocaine skin test is performed by placing lidocaine-soaked gauze under the right breast, and the skin reaction is determined one hour later. Next, the V-shape partial excision of the hymeneal membrane, hymeneal ring, and the hymeneal plate is executed (the vaginal outlet). The size of the V-excision is approximately 1.5 cm between the V-arms, and V-shape arms incisions are connected at the bottom. The excision does not incorporate the posterior peritoneum or posterior-distal vaginal wall. Finally, the vaginal outlectomy excised tissue is submitted to the histological, routine examination and is stained with hematoxylin and eosin (H-E), Fig. 1C.