Robotic-assisted Sigmoid Vaginoplasty in Gender-affirming Surgery

Robotic-assisted surgery has revolutionized minimally invasive surgery, offering enhanced precision, optimized vision, and ergonomic benefits. Sigmoid vaginoplasty is technically challenging when performed through traditional laparoscopic methods. Therefore, we introduced robotic-assisted sigmoid vaginoplasty for a transgender patient. Technique and outcomes are discussed herein. A 45-year-old trans woman underwent robotic-assisted sigmoid vaginoplasty due to insufficient penile skin. The procedure was performed with 4 ports using the da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA) platform for the intra-abdominal part of the surgery. There were no intraoperative complications. The immediate aesthetic outcome was very satisfactory. Unfortunately, the patient did not follow the dilation protocol and required an introitus revision surgery 3 months later. Robotic-assisted sigmoid vaginoplasty yielded favorable outcomes, demonstrating successful surgery and postoperative recovery. The use of robotic technology facilitated precise intra-abdominal manipulation and safe transperineal dissection, contributing to improved surgical outcomes and patient satisfaction. This study described the first European case of robotically assisted sigmoid vaginoplasty, highlighting the potential of minimally invasive techniques in gender-affirming surgery. These encouraging results support the integration of robotic-assisted approaches as a valuable option for transgender individuals seeking vaginoplasty, emphasizing cosmetic outcomes and patient well-being. Continued refinement of the technique is warranted to optimize outcomes and expand its use in transgender healthcare.