Total laparoscopic sigmoid vaginoplasty.
OBJECTIVE
To demonstrate step by step our technique for total laparoscopic sigmoid vaginoplasty.


METHODS
Surgical video tutorial.


METHODS
Academic medical center.


METHODS
Transgender women with penile hypoplasia or with a failed primary vaginoplasty and biological women with either acquired or congenital absence of a functional vagina.


METHODS
An original technique for total laparoscopic sigmoid vaginoplasty is shown on video. Surgery is performed via a simultaneous abdomino-perineal approach. The genital surgeon dissects the neovaginal cavity and performs a bilateral orchiectomy and shortening of the urethra. Out of penile and scrotal skin, a clitoro-vulvaplasty is created. Meanwhile, the laparoscopic surgeon mobilizes the sigmoid segment and transects it down to the base of the sigmoid arteries. The segment is guided in an iso-peristaltic way through the neovaginal tunnel on to the perineum. The distal staple line is opened and sutured in an exaggerated interdigitating fashion to the perineum and inverted penile skin. Length of the segment is measured with a transilluminated perspex dildo, after which the segment is stapled at the proper level. A neovaginopexy is performed on the promontory. Bowel continuity is restored with an intra-abdominal side-to-side oversewn stapled anastomosis. The patient provided written informed consent for the use of this video in this article.


METHODS
None.


RESULTS
Given current literature, intestinal vaginoplasty is associated with low complication rates. Since 2008 our group performed 42 primary and 21 secondary procedures, mainly in transgender women, with at least 1 year of clinical follow-up. Complications comprised three rectal perforations and two anastomotic leakages. These were addressed laparoscopically without long-term fistula formation. There were no conversions to laparotomy.


CONCLUSIONS
Total laparoscopic sigmoid vaginoplasty is a feasible and safe procedure in the hands of an experienced team with the right infrastructure. It provides good surgical and functional results. In selected cases it is indicated for primary vaginoplasty, as well as for revision vaginoplasty.
Gender Surgery Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: mark-bram.bouman@vumc.nl.
Mark-Bram
MB
Bouman
Gender Surgery Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.
Marlon E
ME
Buncamper
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Wouter B
WB
van der Sluis
Gender Surgery Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, the Netherlands.
Wilhelmus J H J
WJ
Meijerink
D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009919:Orchiectomy; D010502:Perineum / Q000601:surgery; D057830:Gender-Affirming Surgery / Q000379:methods*; D017792:Surgical Stapling; D019738:Surgically-Created Structures; D063106:Transgender Persons; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014621:Vagina / Q000601:surgery*
Gender dysphoria; laparoscopic surgery; reconstructive surgical procedures; sex reassignment procedures; sigmoid vaginoplasty; surgical technique