Introduction: There are different strategies in the construction of a neovagina, with no consensus on which is the best approach. We have previously published our experience with sigmoid Monti vaginoplasty via an open approach. In this video, we present a case of neovagina construction by way of sigmoid Monti vaginoplasty, via an intracorporeal robotic-assisted approach. Methods: An 18-year-old transwoman with a long history of gender dysphoria, followed since puberty by a multidisciplinary team, sought definitive gender affirmation surgery. The procedure was performed by two teams working simultaneously, with the external component of the surgery happening whilst the bowel surgery was being performed. The intra-abdominal component of the surgery was performed using one umbilical camera port and 4 additional ports. The neovagina was created using a ~12 cm segment of distal sigmoid colon and detubularized longitudinally before being retubularized to form a Monti cuff by closing the mesenteric edge, while leaving the mesentery in a cephalad position. Dissection into the pouch of Douglas was then performed to advance the neovagina into the perineum, before anastomosis to the surrounding tissues. Results: Total operative time was approximately 8 hours, with the robotic component approximately 5 hours. The postoperative course was uneventful, with expected return of bowel function and adequate pain control, and with discharge on postoperative day 6. The patient reported great satisfaction at 3-month followup. Conclusions: Intracorporeal robotic Monti sigmoid vaginoplasty allows for the construction of a neovagina with a tension-free vascular pedicle, with improved morbidity and quicker time to recovery. This approach allows two surgical teams working simultaneously and preparing the perineum for anastomosis. Our video, the first of its kind to the knowledge of the authors, demonstrates that this approach can be performed in a safe and effective manner. Further pursuit of this approach may be warranted in the right clinical environment. SOURCE OF Funding: None
