Robotic Tubularized Peritoneal Vaginoplasty

Introduction: For transfeminine patients desiring penetrative intercourse, several surgical reconstructive options exist including penile inversion vaginoplasty, peritoneal vaginoplasty, and sigmoid vaginoplasty. Penile inversion vaginoplasty requires preoperative laser hair removal that can be time consuming and costly. Sigmoid vaginoplasty requires bowel harvest and some patients are bothered by excess mucus secretion and odor. Peritoneal vaginoplasty, though without known long-term outcomes, foregoes the need for bowel harvest and preoperative laser hair removal. We present the first video of a robotic tubularized peritoneal vaginoplasty (RATPV) with penile skin inversion. Materials and Methods: We retrospectively reviewed all patients who underwent gender-affirming RATPV at our institution (July 2020–July 2022). Patient demographics, intraoperative details, and postoperative outcomes are described. RATPV involves dissecting and tubularizing a single anterior peritoneal flap (lateral borders: vas deferens, inferior border: retrovesical pouch). The distal end of the tubularized peritoneal flap is then anastomosed to the inverted nonhair bearing penile shaft skin. Results: In 33 patients, median age was 26 years old (interquartile range [IQR]: 24–37) and body mass index was 26 kg/m2 (IQR: 23–32). Median operative time was 406 minutes (IQR: 370–434) and robotic console time was 177 minutes (IQR: 154–220). Intraoperatively, median vaginal depth was 17 cm and diameter was 3+ cm. Median length of stay was 7 days. One-third (15) of patients had a complication within 30 days (40% Clavien–Dindo I, 60% Clavien II). There were no complications related to the robotic reconstruction. Conclusions: RATPV is a safe and effective option for individuals seeking gender-affirming vaginoplasty that obviates the need for laser hair removal before surgery. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No commercial associations occurred during the last 3 years that might create a conflict of interest with this video. Runtime of video: 5 mins 6 secs