Gender-affirming Robotic Tubularized Peritoneal Vaginoplasty: Feasibility and Outcomes

Area of Science:

• Urology
• Gender-affirming surgery
• Minimally invasive surgery

Background:

• Genital gender-affirming surgery (gGAS) aims to align physical characteristics with gender identity.
• Robot-assisted tubularized peritoneal vaginoplasty (RATPV) is a surgical technique for creating a neovagina.

Purpose of the Study:

• To evaluate the outcomes of RATPV in trans-feminine patients undergoing gGAS.
• To compare the efficacy of an initial and an updated RATPV technique.

Main Methods:

• Retrospective review of 33 adult patients undergoing RATPV between July 2020 and July 2022.
• Description of initial and updated surgical techniques, including flap anastomosis.
• Analysis of patient demographics, operative details, and postoperative outcomes.

Main Results:

• Median age was 26 years, median operative time was 406 minutes.
• Postoperative complications within 30 days occurred in 33% of patients (Clavien Dindo I-II).
• Vaginal stenosis occurred in 48% with the original approach versus 10% with the updated approach (P=.05); median depth was 11.3 cm.

Conclusions:

• RATPV is a safe and effective gGAS option for trans-feminine individuals.
• The updated RATPV technique demonstrates a significant reduction in vaginal stenosis.
• This method obviates the need for pre-operative laser hair removal.