Gender-affirming Robotic Tubularized Peritoneal Vaginoplasty: Feasibility and Outcomes

To evaluate the outcomes of robot-assisted tubularized peritoneal vaginoplasty (RATPV) for trans-feminine patients desiring genital gender-affirming surgery (gGAS).

We retrospectively reviewed all patients (adults ≥18 years old) who underwent RATPV for gGAS at our institution (July 2020-July 2022). Initial technique involved anastomosing the peritoneal flap to the introitus. The updated technique anastomosed the flap intraperitoneally to inverted penile shaft skin. Patient demographics, intraoperative details, and postoperative outcomes are described.

In 33 patients, the median age was 26 years old (IQR:24-37) and BMI 26 (IQR:23-32). Median operative time was 406 minutes (IQR: 370-434) and robotic console time 177 minutes (IQR:154-220). Intraoperatively, the median vaginal depth was 17 cm and diameter 3 +cm. Median length of stay was 7 days. One-third (n = 11) of patients had a complication within 30 days postoperatively (40% Clavien Dindo I and 60% Clavien II). No patient had a Clavien III+ complication. At a median follow-up of 499 days (range: 137-835), some degree of vaginal stenosis occurred in 48% (11/23) of patients with the original approach versus 10% (1/10) of those with the newer approach (P = .05). Median vaginal depth was 11.3 cm. Three patients (9%) required revision vaginoplasty, all of whom had the original approach and had difficulty dilating postoperatively. All had clitoral sensation.

RATPV is a safe and effective option for individuals seeking gender-affirming vaginoplasty that obviates the need for laser hair removal prior to surgery. More research is needed into long-term outcomes of this technique.