Gender-affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long-term Outcomes of 500 Cases

To determine the outcomes of robotic peritoneal flap vaginoplasty.

There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making.

A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017 to 2023 was reviewed. Complications requiring procedural intervention, self-reported vaginal dimensions, and orgasm were recorded at each follow-up visit and analyzed as outcomes.

A total of 487 (97%) patients were followed for 3 months, and 425 (85%) for 1 year or greater. Twenty patients (4%) had a complication requiring procedural intervention, and 61 (12%) had elective revision surgery. Median self-reported vaginal depth and width at 1 year was 14.5 cm (14.5-14.5) and 3.8 cm (3.8-3.8 cm). There were 12 patients (4%) no longer dilating using standard dilators at this prescheduled 1-year appointment, and at the last follow-up ≥1 year, 8% were no longer dilating. Thirty-six (8%) of patients were considered anorgasmic at the last follow-up. Difficulty with orgasm before surgery was associated with lower rates of achieving orgasm after surgery and less consistent vaginal depth at 1 year, however, 80% of these patients were able to orgasm after surgery.

Clinician-observed and patient-reported outcomes for robotic gender-affirming peritoneal flap vaginoplasty were superior to those reported in the literature for penile inversion vaginoplasty. Patients who do not achieve orgasm before surgery are less likely to achieve orgasm and maintain vaginal depth afterward, however, the majority of these patients have improved sexual health after surgery.