Abstract
Genitourinary reconstruction for transgender/gender non-binary (TGNB) individuals often involves perineal dissection with challenging surgical exposure. Robotic transabdominal approaches to vaginoplasty or vaginectomy allow for enhanced visualization, improved access to deep pelvic structures, and potential for new reconstructive techniques. We describe novel techniques and preliminary outcomes of robotic-assisted genital gender affirming surgery (GAS). These procedures include primary and revision peritoneal flap vaginoplasty, enteric vaginoplasty, and vaginectomy with vaginal mucosal flap and graft harvest for urethral lengthening. Further optimization of emerging techniques, assessment of long-term results, and the development of standardized outcome measures are critical future directions for robotic GAS.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Dy GW, Sun J, Granieri MA, Zhao LC. Reconstructive management pearls for the transgender patient. Curr Urol Rep. 2018;19(6):36.
Bianchi S, Berlanda N, Brunetti F, Bulfoni A, Ferrero Caroggio C, Fedele L. Creation of a neovagina by laparoscopic modified davydov vaginoplasty in patients with partial androgen insensitivity syndrome. J Minim Invasive Gynecol. 2017;24(7):1211–7.
Jacoby A, Maliha S, Granieri MA, Dy G, Bluebond-Langner R, Zhao LC. Robotic davydov peritoneal flap vaginoplasty for augmentation of vaginal depth in feminizing vaginoplasty. J Urol. 2019;201(6):1171–6.
Fedele L, Frontino G, Restelli E, Ciappina N, Motta F, Bianchi S. Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome. Am J Obstet Gynecol. 2010;202(1):33.e1–6.
Buncamper ME, van der Sluis WB, van der Pas RS, Ozer M, Smit JM, Witte BI, et al. Surgical outcome after penile inversion vaginoplasty: a retrospective study of 475 transgender women. Plast Reconstr Surg. 2016;138(5):999–1007.
Hadj-Moussa M, Ohl DA, Kuzon WM Jr. Feminizing genital gender-confirmation surgery. Sexual Med Rev. 2018;6(3):457–68.e2.
Horbach SE, Bouman MB, Smit JM, Ozer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med. 2015;12(6):1499–512.
Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam J. Long-term outcomes of rectosigmoid neocolporrhaphy in male-to-female gender reassignment surgery. Plast Reconstr Surg. 2015;136(2):386–94.
Herman CJ, Willemsen WN, Mastboom JL, Vooijs GP. Artificial vaginas: possible sources of epithelialization. Hum Pathol. 1982;13(12):1100–5.
Claes KEY, Pattyn P, D'Arpa S, Robbens C, Monstrey SJ. Male-to-female gender confirmation surgery: intestinal vaginoplasty. Clin Plast Surg. 2018;45(3):351–60.
Bouman MB, van der Sluis WB, Buncamper ME, Ozer M, Mullender MG, Meijerink WJ. Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients. Plast Reconstr Surg. 2016;138(4):614e–23e.
Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases. J Sex Med. 2011;8(12):3487–94.
Kim C, Campbell B, Ferrer F. Robotic sigmoid vaginoplasty: a novel technique. Urology. 2008;72(4):847–9.
Baek SK, Carmichael JC, Pigazzi A. Robotic surgery: colon and rectum. Cancer (Sudbury, Mass). 2013;19(2):140–6.
Imparato E, Alfei A, Aspesi G, Meus AL, Spinillo A. Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(12):1465–9.
Hage JJ, Karim RB, Asscheman H, Bloemena E, Cuesta MA. Unfavorable long-term results of rectosigmoid neocolpopoiesis. Plast Reconstr Surg. 1995;95(5):842–8; discussion 9–50
Hage JJ, Bout CA, Bloem JJ, Megens JA. Phalloplasty in female-to-male transsexuals: what do our patients ask for? Ann Plast Surg. 1993;30(4):323–6.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality; 2016.
Massie JP, Morrison SD, Wilson SC, Crane CN, Chen ML. Phalloplasty with urethral lengthening: addition of a vascularized bulbospongiosus flap from vaginectomy reduces postoperative urethral complications. Plast Reconstr Surg. 2017;140(4):551e–8e.
Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, Mullender MG, Groenman F, et al. Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery. J Urol. 2018;200(6):1315–22.
Nikolavsky D, Hughes M, Zhao LC. Urologic complications after phalloplasty or metoidioplasty. Clin Plast Surg. 2018;45(3):425–35.
Groenman F, Nikkels C, Huirne J, van Trotsenburg M, Trum H. Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study. Surg Endosc. 2017;31(8):3363–9.
Weinberg A, Granieri M, Cohen O, Bluebond-Langner R, Levine J, Zhao L. 027 robotic-assisted vaginectomy, mobilization of vaginal mucosa for urethral lengthening and a gracilis muscle flap for phalloplasty: a novel technique for female-to-male genital reconstruction. J Sex Med. 2018;15(2):S13–S4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Dy, G.W., Katz, M., Bluebond-Langner, R., Zhao, L.C. (2021). Robotic Applications in Gender Affirming Genital Surgery. In: Nikolavsky, D., Blakely, S.A. (eds) Urological Care for the Transgender Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-18533-6_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-18533-6_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-18532-9
Online ISBN: 978-3-030-18533-6
eBook Packages: MedicineMedicine (R0)