Robotic Peritoneal Flap Revision of Gender Affirming Vaginoplasty: a Novel Technique for Treating Neovaginal Stenosis

Does plastic surgery need a rewiring? A survey and systematic review on robotic-assisted surgery

“…Dy et al (2021) reported the use of RAS for peritoneal flap revision vaginoplasty. 33 All 24 patients had undergone primary penile inversion vaginoplasty or vulvoplasty, with revision surgery occurring after an average of 35.3 months. Out of 24 patients, only 18 patients presented at a 6-month follow-up and were included in the analysis.…”

“… 26 Other studies that reported on complications, unfortunately, did not provide a non-RAS comparator group, precluding analysis. 27 , 31 , 33 One study instead compared two different robots, however, and did not find any differences in complication rates between the two groups. 34 Although there have been limited studies on outcomes and complications, there appears to be a weakly positive tendency for RAS over non-RAS.…”

“…RAS was used to harvest DIEP flap for breast reconstruction that had no flap loss or abdominal complications, whereas endoscopic harvest elicited two instances of flap loss. 26 Three studies demonstrated no operative complications and flap survival in all patients at final follow-up; 27 , 28 , 33 two of the three studies failed to compare outcomes with traditional cohorts. 27 , 34 Lai et al (2019) noted equal outcomes for both RAS and non-RAS, but also reported that the RAS group used significantly smaller vessels for microanastomosis than non-RAS.…”

The History of Gender-Affirming Vaginoplasty Technique

“…13,19,35,37 However, a new GAV technique has emerged with similar utility in primary cases where genital skin is limited and in revision cases for refractory stenosis. 38,39 Due to the decreased donor site morbidity of this new method, the limited indications for BSV may become even fewer.…”

Surgical Outcomes and Complications of Genital Gender Affirmation Surgery

“…This procedure involves reconstructing male anatomy into homologous female phenotypic anatomy, including a functional neo-vaginal canal and sensate neo-clitoris, enabling satisfactory penetrative intercourse and orgasm and normal urinary function with creation of a perineal urethrostomy [4]. Alternatively, intestinal vaginoplasty and peritoneal vaginoplasty are less commonly performed as primary reconstruction, and are techniques that may be utilized during revisional surgery [5].…”