Abstract
Introduction and Hypothesis
Penile inversion vaginoplasty is the most common method utilized for feminizing genital reconstruction in transgender women. However, vaginoplasty has high revision rates. The most common functional reason for revision is stenosis or shortening of the vaginal canal, which can be challenging to perform.
Methods
We present the step-by-step technique of a robotic peritoneal flap revision vaginoplasty. We discuss the indications and challenges of this surgery. Detailed steps and helpful hints are included. Finally, we outline the postoperative management and expected outcomes.
Results
The robotic peritoneal flap vaginoplasty revision is feasible and safe with total operative time of 3 h, and estimated blood loss of 20 ml. The postoperative pathway includes vaginal packing and Foley catheter removal, as well as discharge within the first week. Serial vaginoscopies are later performed to assess adequate healing and patency of the new perineal pouch.
Conclusions
Finding a viable harvesting site after previous perineal flap surgery is feasible. The robotic revision of peritoneal flap vaginoplasty is an appropriate procedure for re-establishing vaginal canal patency and depth.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00192-026-06617-4.
Keywords: Vaginoplasty, Peritoneal flap, Robotic surgery, Transgender, Surgical technique, Feminizing genital reconstruction
Introduction
Approximately 44 million individuals worldwide are diagnosed with gender dysphoria, with gender affirmation surgery being the most effective treatment. Among various techniques, penile inversion vaginoplasty is the most common method utilized for feminizing genital reconstruction in transgender women [1, 2]. However, vaginoplasty has high revision rates, ranging from 27% to 60%, and indications varying from cosmetic to functional [3].
The most common functional reason for revision is stenosis or shortening of the vaginal canal, with a reported incidence of 12% [3, 4]. This primarily occurs owing to inconsistent or inappropriate use of vaginal dilators [4]. A typical range of 12–16 cm (5–6.5 inches) is expected, so a value lower than this [4] may necessitate revision vaginoplasty. Such revisions can be technically challenging due to the lack of available tissue and scarring from previous dissection. Additionally, limited visualization may constrain the perineal approach.
Methods
We present the step-by-step technique of a robotic peritoneal flap revision vaginoplasty. We discuss the indications and challenges of this surgery. Detailed steps and helpful hints are included. Finally, we outline the postoperative management and expected outcomes.
Results
The robotic peritoneal flap vaginoplasty revision is feasible and safe with total operative time of 3 hours, and estimated blood loss of 20 ml. The postoperative pathway includes vaginal packing and Foley catheter removal, as well as discharge within the first week. Serial vaginoscopies are later performed to assess adequate healing and patency of the new perineal pouch.
Conclusions
Finding a viable harvesting site after previous perineal flap surgery is feasible. The robotic revision of peritoneal flap vaginoplasty is an appropriate procedure for re-establishing vaginal canal patency and depth.
Supplementary Information
Below is the link to the electronic supplementary material.
Funding
Open access funding provided by SCELC, Statewide California Electronic Library Consortium.
Declarations
Patient’s consent
Valeria Celis, Veronica Rodriguez, Laura Fumero, Luis Dubey, Federico Eskenazi, Alegria Lusinchi, Leo Doumanian, Roberto Travieso, and Rene Sotelo acquired the patient’s consent for this study.
Conflicts of interest
None.
Footnotes
Publisher’s Note
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References
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