Summary
Introduction
Younger transgender patients undergoing penile inversion vaginoplasty (PIV) after
pubertal suppression often require modified techniques to augment neovaginal tissue.
Peritoneal flap vaginoplasty (PFV) is a well-established technique for improving neovaginal
depth. Utilizing a Hidden Incision Endoscopic Surgery (HIdES) approach to port placement
improves cosmetic outcomes of this identity-affirming procedure.
Objective
This video shows the efficacy of the HIdES port placement configuration on the daVinci
robot for peritoneal flap creation and closure during PIV using the modified laparoscopic
Davydov procedure.
Materials and methods
Three young adult transgender females who had not undergone laser hair removal/epilation
underwent PIV with robotic PFV utilizing HIdES port placement. The anterior superior
iliac spine (ASIS) was demarcated bilaterally, and ports were placed at or below these
lines. Two surgical teams, external genitoplasty and internal peritoneal flap closure
via daVinci Xi robot, worked simultaneously.
Results
All patients underwent successful robotic assisted PIV with HIdES port placement.
All patients had similar postoperative courses of return of bowel function with flatus
on postoperative day (POD) 2, vaginal dressing, urethral catheter removal, and initiation
of vaginal dilation on POD 5–6, and hospital discharge between POD 5–8.
Conclusion
We present our initial experience with robotic/laparoscopic PFV using a hidden incision
approach. This technique allows for excellent neovaginal depth with improved abdominal
wound aesthetics.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Demographic and temporal trends in transgender identities and gender confirming surgery.Transl Androl Urol. 2019 Jun; 8: 184-190
- Male to female transformation.in: Laub D.R. Gandy P. Proceedings of the second interdisciplinary symposium on GenderDysphoria syndrome. Stanford University Press, Palo Alto, CA1973: 188-194
- Vaginal canal reconstruction in penile inversion vaginoplasty with flaps, peritoneum, or skin grafts: where is the evidence?.Plast Reconstr Surg. 2021; 147: 634e-643e
- Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome.Am J Obstet Gynecol. 2010; 202 (33): e1-e6
- Robotic Davydov peritoneal flap vaginoplasty for augmentation of vaginal depth in feminizing vaginoplasty.J Urol. 2019; 201: 1171-1176
- Hidden incision endoscopic surgery: description of technique, parental satisfaction and applications.J Urol. 2011; 185: 1425-1431
Article info
Publication history
Published online: August 19, 2022
Accepted:
August 15,
2022
Received in revised form:
June 10,
2022
Received:
November 8,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
