Vaginoplasty tips and tricks

Li, Joy S; Crane, Curtis; Santucci, Richard A.

doi:10.1590/s1677-5538.ibju.2020.0338

Cited by 22 publications

(16 citation statements)

References 14 publications

(23 reference statements)

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“…Undeniably, total vaginectomy can have serious in uences on the postoperative sex life of patients with complicated vaginal HSIL. Although vaginoplasty which is a challenging procedure has a high requirement on the surgeon's technique, it can signi cantly improve the satisfactory of sex life [39,40]. Consequently, vaginoplasty can be considered for selected patients who will be performed with total vaginectomy.…”

Section: Discussionmentioning

confidence: 99%

Is robotic-assisted surgery a better choice in vaginectomy of complicated vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery?

Liu

Mao

Bai

et al. 2023

Preprint

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The aim of this study was to evaluate the operative outcomes of robotic-assisted laparoscopic vaginectomy (RALV) and conventional laparoscopic vaginectomy (CLV) for patients with complicated vaginal high-grade squamous intraepithelial lesions (HSIL). Therefore, an analysis of one hundred and nine patients with complicated vaginal HSIL (32 patients in the RALV group and 77 patients in the CLV group) who underwent minimally invasive vaginectomy was conducted retrospectively. Compared with the CLV group, patients in the RALV group demonstrated less estimated blood loss, a lower rate of intraoperative complications and shorter durations of paralytic ileus time, urinary catheter indwelling time and postoperative hospitalization time (all P < 0.05). However, the RALV group had significantly higher hospital costs than the CLV group (P < 0.05). The total operative time, postoperative complications, positive surgical margins, pathology upgrading or treatment outcomes did not significantly differ between the two groups (all P > 0.05). Our results demonstrated that both RALV and CLV can achieve satisfactory treatment outcomes, while RALV has the advantages of less intraoperative blood loss, fewer intraoperative complications and faster postoperative recovery. RALV has the potential to become a better choice for vaginectomy without regard to the burden of hospital costs.

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Section: Discussionmentioning

confidence: 99%

Is robotic-assisted surgery a better choice in vaginectomy of complicated vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery?

Liu

Mao

Bai

et al. 2023

Preprint

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show abstract

“…One of the most devastating complications of transgender vaginoplasty is the development of a rectovaginal fistula. 4 This not only compromises the integrity of the neovagina but also exposes the patient to infection and necessitates additional surgeries to resect the fistula and revise the vaginoplasty. Additional bowel and genitourinary diversion surgeries may be required, which could leave the patient with a colostomy.…”

Section: Discussionmentioning

confidence: 99%

Utilisation of a rectal hydrogel spacer for vaginoplasty in a cadaver model

Mishra

Bukavina

et al. 2022

Journal of Clinical Urology

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Background: A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR™ System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment. Objective: This was a feasibility study performed in a single cadaveric perineum.Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers’ fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach. Results: A satisfactory vaginal length was achieved rapidly and safely. Conclusions: We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided. Level of evidence: Not applicable

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“…Pippi Salle described in 2007 his CSDC, the aim of this revolutionary technique was to dissect the NVB and the glans off the cavernosa, splitting the corpora in the midline leaving two hemicorpora and burying them in a dartos pouch in the labia majora, after removing all erectile tissue. This technique preserves the corpora cavernosa considering that up to 5% of the patients with CAH may have gender dysphoria later in life and a neophallus could be created from the buried corpora cavernosa (24). To our knowledge, at present, there had been no cases reported in literature where feminizing genitoplasty for CAH has to be reverted (2,25).…”

Section: Discussionmentioning

confidence: 99%

Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

2021

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Introduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the fi rst cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies.Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus fl ap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking longterm follow-up, it represents a new step in conservative reconfi guration of the external virilized female genitalia.

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Vaginoplasty tips and tricks

Cited by 22 publications

References 14 publications

Is robotic-assisted surgery a better choice in vaginectomy of complicated vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery?

Is robotic-assisted surgery a better choice in vaginectomy of complicated vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery?

Utilisation of a rectal hydrogel spacer for vaginoplasty in a cadaver model

Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

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