Introduction: We describe our surgical technique and feasibility of robot-assisted sigmoid vaginoplasty (RSV) in transgender females in this pilot study.
Methods: We performed a retrospective cohort study of transgender females undergoing primary or revision RSV in 2020-2021. Variables evaluated include operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), surgical complications, hospital course, post-discharge events (PDE), vaginal depth (VD), and presence of gastrointestinal symptoms, colitis, or neovaginal inflammation >6 months post-operatively.
Our technique of RSV includes a two-team approach with the patient in lithotomy position. In primary cases, robotic harvesting of a 15cm sigmoid segment was performed with a concurrent penile inversion vaginoplasty without scrotal graft. The harvested sigmoid segment was anastomosed to the phallic flap robotically or from below after the proximal and distal colonic segments are anastomosed with a circular stapler.
Results: Demographics, surgical, and hospital course for 7 patients are summarized in Table 1; 30-day readmission was 0%.
Surgical outcomes are summarized in Table 2. 3 patients had vaginal dilation under general anesthesia, of which 1 underwent an additional procedure unrelated to the sigmoid harvesting (meatoplasty). No patients reported a change in bowel habits, colitis, or neovaginal irritation. No patients developed fistulas or bothersome vaginal discharge.
Conclusions: We describe our technique and initial experience for RSV, which is an option for transgender women seeking a primary vaginoplasty or revision vaginoplasty. RSV provides lubrication with good vaginal depth and acceptable risk of complications.
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