The primary surgical technique in our institution for vaginoplasty in Rokitansky Syndrome (RS) has been coloplasty. We present a modified McIndoe technique, incorporating a graft of decellularized porcine small intestinal submucosa (SIS) with a 3D-printed mold to facilitate graft placement.

We present a novel technique performed in a 17-year-old female patient with RS. It involved a SIS extracellular matrix positioned on a 3D-printed polylactic acid mold designed to prevent graft contraction and maintain both width and depth.

surgical technique: The vesico-rectal space was dissected meticulously, ensuring careful avoidance of the urethra and rectum. A vaginal canal measuring 9 cm in length and 4 cm in diameter was created. A 3D-printed vaginal mold, covered with a sterile condom, was inserted with the graft, sutured at its free edges positioned around the mold. It was then secured to the introitus circumference with interrupted non-absorbable sutures.

Four days postoperatively, the mold was removed, revealing a vital and adherent graft. Daily vaginal dilations were initiated. At first the vaginal canal exhibited adequate length but a minor constriction in its distal third, which was resolved by adjusting the size of the dilators. Aesthetic outcomes were satisfactory. A two-month vaginoscopy demonstrated a 9 cm neovagina with favorable diameter and early re-epithelization.

This modified McIndoe technique with SIS graft demonstrated excellent aesthetic results with minimal scarring and invasiveness. The integration of 3D printing technology facilitated the creation of customized molds, enhancing surgical precision. Long-term follow-up will assess functional and aesthetic outcomes.