"Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases"

Gaines Blasdel; Kshipra Hemal; Charlie Dubach-Reinhold; Augustus Parker; Chris Amro; Lee C Zhao; Rachel Bluebond-Langner

doi:10.1097/SLA.0000000000006621

"Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases"

Ann Surg. 2025 Jan 9. doi: 10.1097/SLA.0000000000006621. Online ahead of print.

Authors

Gaines Blasdel¹, Kshipra Hemal², Charlie Dubach-Reinhold³, Augustus Parker², Chris Amro, Lee C Zhao⁴, Rachel Bluebond-Langner²

Affiliations

¹ University of Michigan Medical School and Department of Urology, New York University Langone Medical Center.
² Hansjorg Wyss Department of Plastic and Reconstructive Surgery; New York University; New York, New York.
³ Charlie Dubach-Reinhold, BS. University of California, San Francisco School of Medicine.
⁴ Department of Urology, New York University; New York, New York.

PMID: 39781707
DOI: 10.1097/SLA.0000000000006621

Abstract

Objective: The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty.

Background: There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making.

Methods: A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017-2023 were reviewed. Complications requiring procedural intervention, self-reported vaginal dimensions, and orgasm were recorded at each follow up visit and analyzed as outcomes.

Results: 487 (97%) of patients were followed to 3 months, and 425 (85%) to 1 year or greater. Twenty patients (4%) had a complication requiring procedural intervention, and 61(12%) had elective revision surgery. Median self-reported vaginal depth and width at 1 year was 14.5 cm (14.5-14.5) and 3.8 cm (3.8-3.8 cm). There were 12 patients (4%) no longer dilating using standard dilators at this pre-scheduled 1-year appointment, and at last follow-up ≥1 year, 8% were no longer dilating. Thirty-six (8%) of patients were considered anorgasmic at last follow up. Difficulty with orgasm prior to surgery was associated with lower rates of achieving orgasm after surgery and less consistent vaginal depth at 1 year, however 80% of these patients were able to orgasm after surgery.

Conclusions: Clinician-observed and patient-reported outcomes for robotic gender-affirming peritoneal flap vaginoplasty were superior to those reported in the literature for penile inversion vaginoplasty. Patients who do not achieve orgasm prior to surgery are less likely to achieve orgasm and maintain vaginal depth afterwards, however the majority of these patients have improved sexual health after surgery.