Robotic-assisted Vaginectomy During Staged Gender-affirming Penile Reconstruction Surgery: Technique and Outcomes

Jun, Min Suk; Shakir, Nabeel; Blasdel, Gaines; Cohen, Oriana; Levine, Jamie P.; Bluebond-Langner, Rachel; Zhao, Lee C.

doi:10.1016/j.urology.2021.01.024

Cited by 13 publications

(15 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,29,30 In addition, we have not observed any patients with persistent vaginal remnants. 5,8 Other studies have reported high rates of persistent vaginal remnant, up to 50%. 24,30 In addition to primary vaginectomy and urethral lengthening, we have observed the benefit of the robotic approach in revision vaginectomy for vaginal remnant and/or urethral diverticulum.…”

Section: Surgical Outcomesmentioning

confidence: 98%

“…Robotic techniques have also been applied to masculinizing genital surgery, specifically vaginectomy in the setting of metoidioplasty or phalloplasty. 5 Vaginectomy seeks to completely excise all vaginal epithelium while avoiding injury to the nearby bowel, bladder, urethra, and ureters. Remnant vaginal mucosa has been associated with increased urethral complication including urethrovaginal fistula, postvoid dribbling due to retained urine within the remnant vaginal canal, perineal pain, and recurrent urinary tract infections.…”

Section: Vaginectomy and Urethral Lengtheningmentioning

confidence: 99%

“…Remnant vaginal mucosa has been associated with increased urethral complication including urethrovaginal fistula, postvoid dribbling due to retained urine within the remnant vaginal canal, perineal pain, and recurrent urinary tract infections. 5,24,25 The perineal approach is the most common technique used for vaginectomy and can be associated with difficult operative visualization. A recent study of perineal vaginectomy reported a 10% major complication rate includ-ing injury to the bowel, bladder, ureter, and/or urethra.…”

Section: Vaginectomy and Urethral Lengtheningmentioning

confidence: 99%

“…Since the senior authors' initial description of the robot-assisted peritoneal flap vaginoplasty, 4 indications for use of the robotic surgical system in gender affirming genital surgery have expanded to include revision vaginoplasty as well as primary and secondary vaginectomy. [5][6][7][8] In this article, the authors describe their experience and review their outcomes data applying robotic techniques to a range of gender affirming genital surgeries.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

2023

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Surgical Outcomesmentioning

confidence: 98%

Section: Vaginectomy and Urethral Lengtheningmentioning

confidence: 99%

Section: Vaginectomy and Urethral Lengtheningmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…48 Avoidance of this complication begins with complete, sharp excision of the vaginal mucosa using a transperineal, laparoscopic, or robotically assisted approach, and closure of the vaginal space with suture, 49 whereas some advocate for the use of an additional gracilis flap to further obliterate this space and buttress the urethral anastomosis. 50 Schardein et al 51 reported on histological findings of 18 patients with urethral complications…”

Section: Specific To Phalloplasty and Metoidioplastymentioning

confidence: 99%

“Urinary Reconstruction in Genital Gender-Affirming Surgery: Checking Our Surgical Complication Blind Spots”

Blasdel

Nikolavsky

et al. 2023

Plastic &Amp; Reconstructive Surgery

Self Cite

View full text Add to dashboard Cite

Genital gender-affirming surgery (GGAS) to treat gender incongruence 1 related to genital configuration is based on individual goals and risk tolerance. In gender-affirming penile reconstruction, the primary procedure involves phalloplasty or a metoidioplasty, 2 and additional components with urologic implications Background: Urologic complications in genital gender-affirming surgery are imperfectly measured, with existing evidence limited by "blind spots" that will not be resolved through implementation of patient-reported outcomes alone. Some blind spots are expected in a surgical field with rapidly expanding techniques, and they may be exacerbated by factors related to transgender health. Methods: The authors provide a narrative review of systematic reviews published in the past decade to describe the current options for genital genderaffirming surgery and surgeon-reported complications, as well as contrasting peer-reviewed sources with data not reported by the primary surgeon. In combination with expert opinion, these findings help estimate complication rates. Results: Eight systematic reviews describe complications in patients undergoing vaginoplasty, including 5% to 16.3% mean incidence of meatal stenosis and 7% to 14.3% mean incidence of vaginal stenosis. Compared with surgeonreported cohorts, patients undergoing vaginoplasty or vulvoplasty in other reports had higher rates of voiding dysfunction (47% to 66% versus 5.6% to 33%), incontinence (23% to 33% versus 4% to 19.3%), or misdirected urinary stream (33% to 55% versus 9.5% to 33%). Outcomes in six reviews of phalloplasty and metoidioplasty included urinary fistula (14% to 25%), urethral stricture or meatal stenosis (8% to 12.2%), and ability to stand to void (73% to 99%). Higher rates of fistula (39.5% to 56.4%) and stricture (31.8% to 65.5%) were observed in alternate cohorts, along with previously unreported complications such as vaginal remnant requiring reoperation. Conclusions: The literature does not completely describe urologic complications of genital gender-affirming surgery. In addition to standardized, robustly validated patient-reported outcome measures, future research on surgeonreported complications would benefit from using the IDEAL (idea, development, exploration, assessment, and long-term study) framework for surgical innovation.

show abstract

How Should Surgeons Approach Gender-Affirming Surgery Revisions When Patients Were Not, Perhaps, Well Informed in Prior Counseling?

2023

AMA Journal of Ethics

View full text Add to dashboard Cite

Surgeons often encounter patients with realistic goals yet who desire unrealistic means of achieving them. This tension is compounded when surgeons consult with patients eager to revise a prior gender-affirming procedure completed by another surgeon. Two key factors of ethical and clinical relevance are that (1) a consulting surgeon's job is complicated when a population-specific evidence base is lacking and (2) a patient's marginalization is exacerbated by their having suffered the downstream effects of compromised initial access to comprehensive, realistic surgical care. This case commentary about revision of gender-affirming phalloplasty canvasses the pitfalls of a limited evidence base and focuses on strategies surgeons can use to help guide consultation. In particular, informed consent discussion may need to reframe a patient's expectations about clinical accountability for irreversible interventions.

show abstract

Robotic-assisted Vaginectomy During Staged Gender-affirming Penile Reconstruction Surgery: Technique and Outcomes

Cited by 13 publications

References 11 publications

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

Robotics in Gender Affirming Surgery: Current Applications and Future Directions

“Urinary Reconstruction in Genital Gender-Affirming Surgery: Checking Our Surgical Complication Blind Spots”

How Should Surgeons Approach Gender-Affirming Surgery Revisions When Patients Were Not, Perhaps, Well Informed in Prior Counseling?

Contact Info

Product

Resources

About