Mending the Gap: AlloDerm as a Safe and Effective Option for Vaginal Canal Lining in Revision Robotic Assisted Gender Affirming Peritoneal Flap Vaginoplasty

Parker, Augustus; Brydges, Hilliard T.; Blasdel, Gaines; Bluebond-Langner, Rachel; Zhao, Lee C.

doi:10.1016/j.urology.2023.01.003

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…This framework allows for epithelialization within 3-6 weeks while remaining non-immunogenic. Parker et al described using AlloDerm in revision peritoneal flap vaginoplasty cases when there is insufficient peritoneal flap length to reach the remnant vaginal canal [55]. The allograft was used in lieu of their prior approach of utilizing extra-genital skin grafts to bridge this gap.…”

Section: Allograft and Xenograftmentioning

confidence: 99%

“…Although these reported techniques both eliminate additional donor site morbidity, experience with their use is limited, and longterm outcomes, including tissue incorporation and lubrication, are unclear. The additional cost of tissue processing should also be considered ($30/cm 2 for AlloDerm) [55]. Most surgical teams do not offer the use of xenografts due to skepticism of their viability and the abundant availability of autologous tissue options.…”

Section: Allograft and Xenograftmentioning

confidence: 99%

“…In one series, 22% of patients were demonstrated postoperatively to have areas of excess AlloDerm that did not epithelialize and required excision. This area was noted to be at the junction of the allograft and peritoneal flaps [55]. The use of allografts is generally reserved for complex revision cases where more common lining options such as skin and peritoneum are insufficient.…”

Section: Allograft and Xenograftmentioning

confidence: 99%

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Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Bene,

Ferrin,

et al. 2024

JCM

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Gender-affirming vaginoplasty (GAV) comprises the construction of a vulva and a neovaginal canal. Although technical nuances of vulvar construction vary between surgeons, vulvar construction is always performed using the homologous penile and scrotal tissues to construct the corresponding vulvar structures. Therefore, the main differentiating factor across gender-affirming vaginoplasty techniques is the tissue that is utilized to construct the neovaginal canal. These tissue types vary markedly in their availability, histology, and ease of harvest and have different advantages and disadvantages to their use as neovaginal lining. In this narrative review, the authors provide a comprehensive overview of the tissue types and associated operative approaches used for construction of the neovagina in GAV. Tissue choice is guided by several factors, such as histological similarity to natal vaginal mucosa, tissue availability, lubrication potential, additional donor site morbidity, and the specific goals of each patient. Skin is used to construct the neovagina in most cases with a combination of pedicled penile skin flaps and scrotal and extra-genital skin grafts. However, skin alternatives such as peritoneum and intestine are increasing in use. Peritoneum and intestine are emerging as options for primary vaginoplasty in cases of limited genital skin or revision vaginoplasty procedures. The increasing number of gender-affirming vaginoplasty procedures performed and the changing patient demographics from factors such as pubertal suppression have resulted in rapidly evolving indications for the use of these differing vaginoplasty techniques. This review sheds light on the use of less frequently utilized tissue types described for construction of the neovaginal canal, including mucosal tissues such as urethral and buccal mucosa, the tunica vaginalis, and dermal matrix allografts and xenografts. Although the body of evidence for each vaginoplasty technique is growing, there is a need for large prospective comparison studies of outcomes between these techniques and the tissue types used to line the neovaginal canal to better define indications and limitations.

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Section: Allograft and Xenograftmentioning

confidence: 99%

Section: Allograft and Xenograftmentioning

confidence: 99%

Section: Allograft and Xenograftmentioning

confidence: 99%

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Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Bene,

Ferrin,

et al. 2024

JCM

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“…Estimated epithelization should occur within 3 to 6 weeks. Tubularized AlloDerm has been used as an intervening segment between the remnant neovaginal lining and the peritoneal flaps if there is insufficient peritoneal flap or tissue for neovaginal canal [21]. If the apex of the neovaginal canal is stenotic, this is incised from a robotic intrabdominal approach.…”

Section: Considerations For Limitations For Insufficient Canalmentioning

confidence: 99%

Peritoneal Vaginoplasty in Gender Diverse Patients

Haile,

Agrawal,

Fascelli

2024

Curr Obstet Gynecol Rep

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Purpose of Review To describe robotic-assisted peritoneal vaginoplasty in the genital gender affirming surgical setting and demonstrate existing surgical outcomes. Recent Findings Robotic peritoneal vaginoplasty is similar to a posterior approach to a robotic-assisted laparoscopic prostatectomy and can be done utilizing both multi-port and single port robotic platforms. Neovaginal canal depths and widths of 14 ± 0.7 cm by 3.6 ± 0.2 cm respectively can be obtained. Peritoneal flaps can also augment neovaginal depth by approximately 5 cm beyond the length of a skin graft or flap, proving advantageous in cases of genital hypoplasia or canal depth loss requiring revision. Patients typically report high sexual satisfaction following vaginoplasty. Summary The robotic peritoneal vaginoplasty as a genital gender affirming surgery offers additional neovaginal depth, with reported low complication rates, acceptable cosmesis, and satisfactory sexual function. Ongoing research in alternative grafts and revision remain to be studied.

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“…In these cases, full-thickness skin graft or acellular dermal matrix, which obviates the need for a secondary donor site, can be used to line the interval between the peritoneal flaps and the remnant canal. 23…”

Section: Surgical Outcomesmentioning

confidence: 99%

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

2023

Self Cite

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Genital surgery for the treatment of gender dysphoria has undergone significant evolution since its inception in the first half of the 20th century. Robotic approaches to the pelvis allow for improved visualization and reduced abdominal wall morbidity, making the robotic surgical system a very useful tool in the gender affirming genital surgeon's armamentarium. In penile inversion vaginoplasty, robotically harvested peritoneal flaps can be used to augment the vaginal canal, thereby leading to improved vaginal depth, as well as improve operative efficiency by facilitating a two-surgeon approach. In transgender men, the robotic approach to vaginectomy assists with visualization to confirm complete obliteration of the vaginal canal. Robotic surgery will play a central role in the continued evolution of the field of gender affirming surgery.

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Mending the Gap: AlloDerm as a Safe and Effective Option for Vaginal Canal Lining in Revision Robotic Assisted Gender Affirming Peritoneal Flap Vaginoplasty

Cited by 8 publications

References 23 publications

Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Peritoneal Vaginoplasty in Gender Diverse Patients

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

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