Robot-Assisted Peritoneal Flap Vaginoplasty Versus Penile Inversion Vaginoplasty for Gender Affirming Surgery.

BACKGROUND

Direct comparison of robot-assisted peritoneal flap (PF) to penile inversion (PI) vaginoplasty for gender affirming surgery is absent.

OBJECTIVES

We sought to compare these two techniques to aid patient decision-making.

MATERIALS AND

METHODS

A retrospective case-control study of patients who underwent primary PI (N = 40) or PF (N = 40) vaginoplasty by one of two surgeons at a single center from 2020 to 2023 was conducted.

RESULTS

PF yielded greater vaginal depth at 1 month (18 cm [13-20] vs. 15 cm [4.0-23], p < 0.01) and 6 months (18 cm [11-20] vs. 15 cm [2.5-19], p < 0.01) compared to PI, despite shorter preoperative phallic skin length. No rectal injuries occurred with PF versus three with PI. PF had less estimated blood loss than PI (p < 0.01). Length of stay, operative time, vaginal stenosis, vault granulation tissue, and transfusion rates were similar among groups.

DISCUSSION: This early institutional experience demonstrated that primary PF yielded longer perioperative vaginal depth compared to PI with short-term stability at 6 months, despite shorter preoperative phallic skin length. Complication rates were similar among techniques.

CONCLUSION

Both PF and PI are safe options for gender affirming vaginoplasty with low risk of complications that warrant ongoing use and future study.