A single pedicled robotic peritoneal flap in penile inversion vaginoplasty augmentation

Objectives: To develop a surgical technique to achieve greater depth of the neovaginal cavity in transgender patients undergoing scrotovaginoplasty, and to propose a method for restoring neovaginal integrity in case of lack of genital skin or reduction of the depth due to scarring after infections or ischaemic processes.

Methods: Eight patients were selected to undergo scrotovaginoplasty with scrotal graft and peritoneal flap augmentation in one operating session as a modification of Zhao's original technique. The age of the patients ranged from 25 to 65 years. The first step of the procedure was standard penile inversion vaginoplasty, avoiding suturing of the superior side of the skin cylinder. The skin cylinder was pushed into the abdominal cavity through the perineal access. Afterwards a laparoscopic/robotic approach was used: a single peritoneal flap was harvested from the posterior bladder surface, incised, dissected, pedicled on the neovaginal dome, overturned and and sutured all-round to the neovagina. The sides were adapted to obtain a 'cul-de-sac'.

Results: The average operating time was 6 ± 1.5 h, and patients' hospitalization lasted 6 days. There were no intra- or postoperative complications. Postoperative management was the same as that usually reported in BJUI for patients undergoing standard scrotovaginoplasty.

Conclusions: The use of this technique represents a good solution for increasing neovaginal depth by harvesting a large peritoneal vascularized flap, without significantly affecting postoperative management or increasing complications, as frequently observed using the colovaginoplasty technique.