Robotic Peritoneal Flap Revision Vaginoplasty: Step-by-Step Technique: Tips & Tricks

INTRODUCTION AND HYPOTHESIS: Penile inversion vaginoplasty is the most common method utilized for feminizing genital reconstruction in transgender women. However, vaginoplasty has high revision rates. The most common functional reason for revision is stenosis or shortening of the vaginal canal, which can be challenging to perform. METHODS: We present the step-by-step technique of a robotic peritoneal flap revision vaginoplasty. We discuss the indications and challenges of this surgery. Detailed steps and helpful hints are included. Finally, we outline the postoperative management and expected outcomes. RESULTS: The robotic peritoneal flap vaginoplasty revision is feasible and safe with total operative time of 3 h, and estimated blood loss of 20 ml. The postoperative pathway includes vaginal packing and Foley catheter removal, as well as discharge within the first week. Serial vaginoscopies are later performed to assess adequate healing and patency of the new perineal pouch. CONCLUSIONS: Finding a viable harvesting site after previous perineal flap surgery is feasible. The robotic revision of peritoneal flap vaginoplasty is an appropriate procedure for re-establishing vaginal canal patency and depth.