Robotic assisted ileo-vaginoplasty for vaginal atresia

Vaginal agenesis is a rare congenital disorder of female genital tract. Vaginal reconstruction using bowel segment is usually offered last when dilatation and/or prior vaginal reconstruction attempts using graft or flap has failed. Traditionally accomplished using open surgical approach, we describe here our initial experience of robotic-assisted ileo-vaginoplasty. The index patient presents to us with inadequate vaginal depth after failed buccal mucosal graft vaginoplasty. With the patient in low lithotomy position, port placement and docking of the robot was done. Isolation of ileal segment, closure at its proximal end and end-to-end bowel anastomosis was accomplished successfully. However, in view of dense adhesions the subsequent pull-down of the ileal segment into the perineum could not be done safely. The procedure was completed using combined abdomino-perineal open approach. A vaginal stent (in the ileal segment) and a catheter (in the introitus) were placed post-operatively. Post-operative recovery was uneventful. At 2-weeks, 3 months and a subsequent 1 year follow-up Cystoscopy and examination under anesthesia revealed an adequate vaginal depth with patient reporting successful vaginal dilatation. Robotic reconstruction of vagina using bowel segment in select patient, is safe and feasible, but possible with formidable surgical experience.