V09-06 SINGLE-PORT ROBOT-ASSISTED TUBULARIZED URACHUS-PERITONEAL HINGE-FLAP SALVAGE GENDER-AFFIRMING VAGINOPLASTY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V09-06 SINGLE-PORT ROBOT-ASSISTED TUBULARIZED URACHUS-PERITONEAL HINGE-FLAP SALVAGE GENDER-AFFIRMING VAGINOPLASTY Maurice Garcia, Shannon Smith, Jenna Stelmar, Nance Yuan, Amit Gupta, Samhita Mallavarapu, and Hyung Kim Maurice GarciaMaurice Garcia More articles by this author , Shannon SmithShannon Smith More articles by this author , Jenna StelmarJenna Stelmar More articles by this author , Nance YuanNance Yuan More articles by this author , Amit GuptaAmit Gupta More articles by this author , Samhita MallavarapuSamhita Mallavarapu More articles by this author , and Hyung KimHyung Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A morbid complication of gender affirming vaginoplasty surgery is loss neovaginal canal depth. Options to restore depth are limited. Some surgeons describe increasing depth by opening the fore-shortened vaginal canal into the pelvis and then gathering peritoneum adherent to the bladder and rectum together to enclose the vaginal canal opening into pelvis. Two principal disadvantages of this technique are that: 1. The rectum is, by necessity, incorporated as a wall of the vaginal canal; and 2. The gathering sutures remain to tension, especially during rectal filling. We describe a novel alternative technique that utilizes peritoneum from the urachus and anterior bladder dome to restore vaginal length, and show that it can be easily performed via a dual approach using a single-port robot-assisted and trans-vaginal technique. We also highlight technical innovations we developed. METHODS: From a view optimized by the Lap SP camera, we identify the location of the remnant vaginal canal vault, and incise the peritoneum horizontally over a dilator in the canal space. Anterior vaginal canal is anastomosed to peritoneum anterior to the incision, and the peri-umbilical end of our flap (Figure 1a) is anastomosed to the posterior edge. Our flap completely anteriorly based (uses a 3-layer flap of peritoneum, urachus and Transversalis fascia, from the umbilicus to the anterior bladder dome), and completely excludes the rectum. Our tubularized flap suture-lines are subject to tension only during filling of the vaginal canal, and has no sutures at the vault-end. RESULTS: (See video) Our novel technical innovations not described in the literature for peritoneal vaginoplasty include: 1. Design of a novel hollow vaginal dilator for intra-op (lighted transillumination) and post-op use (dilation/douching) (b-d); 2. Vaginal insertion of our lighted dilator to confirm location of the remnant vaginal-vault (e); 3. Excision of the Seminal vesicles to un-obstruct the canal space (f); and 4. A spatulated/offset anterior/posterior vaginal-peritoneal anastomosis (g). CONCLUSIONS: Our flap is based on anatomy quite familiar to the urologic surgeon: the urachus. It is technically simple to perform, and our innovations render it safer with better outcomes. Clinical outcomes presented in: Smith, Garcia, et al, Sex. Med., 2022. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e838 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maurice Garcia More articles by this author Shannon Smith More articles by this author Jenna Stelmar More articles by this author Nance Yuan More articles by this author Amit Gupta More articles by this author Samhita Mallavarapu More articles by this author Hyung Kim More articles by this author Expand All Advertisement PDF downloadLoading ...