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Robotic Gender Affirming Reconstruction with Peritoneal Flap Vaginoplasty using a Hidden Incision Technique
Arthi Hannallah, MD1, Andrew Cowan, BA2, ZoŽ G. Baker, PhD, MPH1, S. Scott Sparks, MD1, Jessica Lee, MD1, Paul Kokorowski, MD, MPH1.
1Children's Hospital Los Angeles, Los Angeles, CA, USA, 2University of Southern California, Los Angeles, CA, USA.

BACKGROUND: The hidden incision endoscopic surgery (HIdES) technique is well described for pediatric robotic surgery. We report the use of HIdES-based technique for robotic gender affirming reconstruction in young adult transgender females utilizing peritoneal flap harvest.
METHODS: This is a case series of three young adult transgender female patients who had previously undergone hormonal treatment as well as psychological evaluation. The patients all met the World Professional Association for Transgender Health (WPATH) standards to qualify for gender affirming surgery. All patients underwent simultaneous penile inversion vaginoplasty with robotic peritoneal harvest.
RESULTS: All three patients were aged between 18 and 19 years of age, and had undergone hormone treatment previously. Mean BMI was 23.58 and none of the patients had prior abdominal surgical histories. All of the patients tolerated the surgery well, and had their foley catheters and vaginal packings removed with initiation of vaginal dilation on postoperative day 5 or 6. Patients were discharged upon having bowel movements, ambulating, and with adequate pain control. On most recent follow ups, the patients were able to dilate utilizing either a 3.5-inch or 3.9-inch circumference dilator.
CONCLUSIONS: Robotic HIdES peritoneal flap harvest vaginoplasty is a feasible approach to performing gender affirming vaginal reconstruction in transgender patients. The procedure is tolerated well with successful early vaginal dilation.


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