Robotic Management of Peritoneal Inversion Following Vaginoplasty

Abstract

Introduction and Objectives:

Approximately 44 million individuals worldwide are diagnosed with gender dysphoria, with gender affirmation surgery being the most effective treatment. Among various techniques, penile inversion vaginoplasty is the most common method utilized for feminizing genital reconstruction in transgender women. However, vaginoplasty has high revision rates, ranging from 27% to 60%, and indications varying from cosmetic to functional. The most common functional reason for revision is stenosis, or shortening of the vaginal canal, with a reported incidence of 12%. This primarily occurs due to inconsistent or inappropriate use of vaginal dilators. A typical range of 12–16 cm (5–6.5 inches) is expected, so a value lower than this may necessitate revision vaginoplasty. Such revisions can be technically challenging due to the limited availability of tissue and scarring from previous dissections. Additionally, limited visualization may constrain the perineal approach.

Methods:

We present the step-by-step technique of a robotic peritoneal flap revision vaginoplasty. We discuss the indications and challenges of this surgery. Detailed steps and helpful hints are included. Finally, we outline the postoperative management and expected outcomes.

Results:

The robotic peritoneal flap vaginoplasty revision is feasible and safe, with a total operative time of 3 hours and an estimated blood loss of 20 mL. The postoperative pathway includes vaginal packing and Foley catheter removal, as well as discharge within the first week. Serial vaginoscopies are later performed to assess adequate healing and patency of the new perineal pouch.

Conclusions:

Finding a viable harvesting site after previous perineal flap surgery is feasible. The robotic revision of peritoneal flap vaginoplasty is an appropriate procedure for restoring vaginal canal patency and depth.

The authors declare no conflicts of interest.

The author (s) have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.

Technique Tips & Tricks.

Runtime of video: 6 mins 22 secs.