Robot-Assisted Peritoneal Flap Vaginoplasty Versus Penile Inversion Vaginoplasty for Gender Affirming Surgery

Area of Science:

• Gender Affirming Surgery
• Surgical Techniques
• Reconstructive Urology

Background:

• A direct comparison between robot-assisted peritoneal flap (PF) vaginoplasty and penile inversion (PI) vaginoplasty for gender-affirming surgery is currently lacking.
• Understanding the differences between these techniques is crucial for informed patient decision-making.

Purpose of the Study:

• To compare the outcomes of robot-assisted PF vaginoplasty versus PI vaginoplasty.
• To provide data to assist patients in choosing the most suitable vaginoplasty technique.

Main Methods:

• A retrospective case-control study was conducted involving 80 patients (40 PF, 40 PI) who underwent primary vaginoplasty between 2020 and 2023.
• Data were collected and analyzed to compare surgical outcomes and complication rates between the two techniques.

Main Results:

• Peritoneal flap (PF) vaginoplasty resulted in significantly greater vaginal depth at 1 and 6 months postoperatively compared to penile inversion (PI) vaginoplasty (p < 0.01).
• PF vaginoplasty demonstrated reduced estimated blood loss and had no instances of rectal injury, unlike PI vaginoplasty which had three such injuries.
• Key outcomes such as length of stay, operative time, vaginal stenosis, granulation tissue, and transfusion rates were comparable between the PF and PI groups.

Conclusions:

• Early institutional experience indicates that primary PF vaginoplasty achieves longer vaginal depth with short-term stability compared to PI vaginoplasty.
• Both PF and PI vaginoplasty techniques are demonstrated to be safe and effective for gender-affirming surgery with low complication risks.
• Further research and ongoing use of both techniques are warranted for gender-affirming care.