Robotic Ileal Neovaginoplasty for Vaginal Reconstruction: A Report of Two Cases

Neovaginal reconstruction remains technically challenging in patients with congenital or acquired vaginal agenesis. Ileal segment vaginoplasty is a well-established option because of its favorable mucosal characteristics, natural lubrication, and long-term patency. Robotic-assisted surgery provides enhanced precision, improved ergonomics, and superior access to the deep pelvis, making it well-suited for complex reconstructive procedures. This case series reports two patients with vaginal agenesis who underwent robotic-assisted ileal neovaginoplasty using a standard four-port robotic platform. A 10 cm segment of terminal ileum was isolated with intact mesentery, mobilized, and anastomosed to a surgically created neovaginal canal after pelvic dissection. Both patients had uneventful intraoperative and postoperative courses, with minimal blood loss and operative times of 120 and 165 minutes. Recovery was smooth, with early ambulation and discharge on postoperative day four. At six-month follow-up, both patients had stable neovaginal depth, good cosmesis, and satisfactory functional outcomes without stenosis or significant mucous discharge. Robotic ileal neovaginoplasty appears to be a safe and effective minimally invasive option for vaginal reconstruction in selected patients.