Gender-affirming robot-assisted sigmoid vaginoplasty: Outcomes and complications from a retrospective review of 12 cases

Gender-affirming surgery significantly improves the quality of life in transfeminine individuals. Among the various techniques available, sigmoid colon vaginoplasty offers both anatomical and functional advantages. However, conventional approaches are associated with high morbidity. Thus, we aimed to evaluate the outcomes of robot-assisted sigmoid vaginoplasty, emphasizing the complications and clinical results. Between July 2021 and March 2023, 12 patients underwent robot-assisted sigmoid vaginoplasty. Preoperative assessments included colonoscopy and abdominal computed tomography. Flap preparation and canal dissection were performed using a da Vinci XI platform. Postoperative management included vacuum-assisted closure dressing, bed rest, and vaginal dilator use. Clinical outcomes, complications, and sexual activity (SA) were retrospectively analyzed. The mean patient age was 27.9 years (95% confidence interval [CI]: 21.8-34.0). The mean total operative time was 544.8 minutes (95% CI: 494.4-595.1). Intraoperative complications were not observed. The mean vaginal length achieved was 14.6 cm (95% CI: 12.9-16.3), with no cases of vaginal stenosis. Positive SA was reported in 75% of the cases. The overall postoperative complication rate was 41.7% (5/12). Complications included ileus (2 cases, Grade II), vaginal prolapse (1 case, Grade IIIa), anastomotic leakage (1 case, Grade IIIb), and colon flap necrosis (1 case, Grade IIIb), all of which were successfully managed. Robot-assisted sigmoid vaginoplasty demonstrated favorable functional and aesthetic outcomes with manageable complications. However, anastomotic leakage and flap necrosis highlight the importance of careful consideration of vascular supply. Further comparative studies are required to evaluate its advantages over peritoneal vaginoplasty.