Introduction: Gender-Affirming vaginoplasty comprises vulvar and vaginal canal creation.1 Those procedures can be considered separately, and we focus our video-article on vaginal canal construction. In male-to-female transgender surgery, penile skin inversion to line the neovagina is considered the gold standard procedure.2 In our experience, the combination of this technique with The Davydov procedure, commonly used for vaginoplasty in female patients with Mayer-Rokitansky-Kuster-Hauser-Syndrome (MRKH) 3 grants an excellent depth of the vaginal canal, and great comfort to the patient during vaginal intercourse.
Methods: This video abstract features the vaginal canal creation in a 33-year-old male with a long-standing history of gender dysphoria. The intervention starts with the peritoneal walls harvesting at the level of Douglas Pouch, to create a vascular pedicled peritoneal flap. Next, a careful robotic perineal body dissection allowed us establishing external communication of the neovaginal canal. Afterward, the robotic-assisted anastomosis between the previously dissected inverted penile skin and the peritoneal flap is carried. The vaginal cuff closure and colpopexy finish the intervention.
Results: Operative time was 140 minutes, blood loss 80 cc, a perineal pack, and a Foley catheter were placed after the intervention and removed on the 7th postoperative day. The patient remained hospitalized for two days. There were no reported complications other than some right labia minora epidermolysis on the 6th postoperative day which has since resolved. The vaginal dimension at the 4th postoperative month is 6 inches in depth. Periodic dilations with a 1.5 inches dilator are needed.
Conclusions: The combination of robotic-assisted laparoscopic pedicled peritoneal flap vaginoplasty with penile skin inversion technique represents a feasible and reliable option for patients interested in male-to-female transgender surgery.