Photo Credit: Marco Marca
The following is a summary of “Gender-Affirming Robotic Tubularized Peritoneal Vaginoplasty: Feasibility and Outcomes,” published in the September 2024 issue of Urology by Johnston et al.
This study aims to assess the outcomes of robot-assisted tubularized peritoneal vaginoplasty (RATPV) for trans-feminine individuals seeking genital gender-affirming surgery (gGAS). Researchers retrospectively reviewed cases of RATPV performed at the institution from July 2020 to July 2022, focusing on patient demographics, intraoperative details, and postoperative results. The procedure initially involved anastomosing a peritoneal flap to the introitus, while the updated technique connected the flap intraperitoneally to inverted penile shaft skin.
The cohort consisted of 33 patients with a median age of 26 years (interquartile range [IQR]: 24-37) and a median body mass index (BMI) of 26 (IQR: 23-32). The median operative time was 406 minutes (IQR: 370-434), with a robotic console time of 177 minutes (IQR: 154-220). Intraoperatively, the median vaginal depth achieved was 17 cm, with a diameter exceeding 3 cm. The median hospital stay was 7 days. Within 30 days post-surgery, 33% of patients experienced complications, categorized as 40% Clavien-Dindo grade I and 60% grade II, with no Clavien-Dindo grade III or higher complications reported. At a median follow-up of 499 days (range: 137-835), 48% of patients who underwent the original technique exhibited some degree of vaginal stenosis compared to 10% in those who received the updated approach (p = 0.05).
The median vaginal depth at follow-up was 11.3 cm. Revision vaginoplasty was necessary for 9% of patients, all of whom had the original approach and encountered postoperative dilation difficulties. Notably, all patients retained clitoral sensation. RATPV demonstrates safety and efficacy for gender-affirming vaginoplasty, eliminating the need for preoperative laser hair removal. Further research is warranted to explore the long-term outcomes of this surgical technique.
Source: sciencedirect.com/science/article/abs/pii/S0090429524007891
