Vaginoplasty in Male-to-Female Transsexual Surgery: A Training Concept Incorporating Dissection Room Experience to Optimize Functional and Cosmetic Results.
BACKGROUND
Learning a new technique, even for an established surgeon, requires a learning curve; however, in transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results due to a learning curve.


OBJECTIVE
In this context, we have tried to build a learning concept for vaginoplasty that includes four steps: (i) formal identification of the surgical steps in order to provide both measure of surgical process and measures of outcomes; (ii) training on cadavers with expert assistance; (iii) performing the live surgery with assistance from expert; and (iv) performing the surgery alone. Herein, we emphasize the second step of our learning concept.


METHODS
Between September 2013 and December 2013, 15 cadavers were operated on by an established surgeon learning vaginoplasty under assistance from two expert practitioners. Mean global time and mean time necessary to perform each step of the operation were recorded by the experts. Intraoperative complications were systematically registered. The final depth and diameter of the neaovaginal cavity were precisely measured. For each cadaver, the aesthetic results were assessed by one of the experts.


RESULTS
Mean total operating time was 179 ± 34 minutes and decreased from 262 minutes for the first training attempt to 141 minutes for the last one. Intraoperative expert correction included modification of the scrotal triangular flap design and change of position of the urethra: This happened during the first training. No lesion of the urethra or of the anus occurred. The two experts judged the outcomes as excellent in seven cases, very good in four cases, good in two cases, and fair in two cases.


CONCLUSIONS
Despite the numerous reports on vaginoplasty in the literature, there is a real lack of published information on the learning curve of this operation. We make the hypothesis that introducing a learning concept with assistance from expert practitioners at the beginning of the surgeon's experience can optimize both the duration of his learning curve and reduce the risk of major complications.
Centre of Expertise for Sex Reassignment Surgery, Department of Plastic & Transsexual Surgery, Burn Surgery, Hand Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Bordeaux, France.
Franck Marie
FM
Leclère
Centre of Expertise for Sex Reassignment Surgery, Department of Plastic & Transsexual Surgery, Burn Surgery, Hand Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Bordeaux, France.
Vincent
V
Casoli
Centre of Expertise for Sex Reassignment Surgery, Department of Plastic & Transsexual Surgery, Burn Surgery, Hand Surgery, CHU University of Bordeaux, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, Bordeaux, France.
Romain
R
Weigert
D000328:Adult; D001504:Beauty; D002102:Cadaver; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D061646:Operative Time; D010413:Penis / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D057830:Gender-Affirming Surgery / Q000379:methods*; D013524:Surgical Flaps; D063106:Transgender Persons; D014521:Urethra / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
Learning Curve; Male-to-Female Transsexual; Sex Reassignment Surgery; Transsexualism; Vaginoplasty