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The Benefits of Robotic-Assisted Peritoneal Vaginoplasty

Benefits of Robotic-Assisted Peritoneal Flap VaginoplastyRobotic-assisted peritoneal flap vaginoplasty is an advancement in gender-affirming surgery that allows for consistent vaginal depth leaving the majority of the genital tissue for vulvar reconstruction. The use of the robot improves visualization, reducing the risk of injury to the bowel and bladder and minimizes bleeding.

Basics of Peritoneal Flap Vaginoplasty

Peritoneal flap vaginoplasty is a technique in which surgeons use a section of the peritoneum, the thin membrane that lines the abdominal cavity, to line the deeper portion of the neovagina. The peritoneum is a tissue that is both smooth hairless and pliable, making it an ideal option for lining a functional neovagina.

One of the major advantages of the peritoneal flap technique is its ability to create full vaginal depth, regardless of a patient’s presurgical anatomy. A recent study of 500 patients who underwent robotic peritoneal flap vaginoplasty at NYU Langone reported the median vaginal depth achieved was 14.5 cm, with a width of 3.8 cm, comparable to or exceeding traditional penile inversion outcomes.

While peritoneal flap vaginoplasty can be performed without the use of robotic technology, there are clear benefits to the robotic approach.

How Robotic Surgery Works

Robotic surgery is a minimally invasive technique in which surgeons use instruments mounted on robotic arms. These instruments enter the body through small incisions, giving the surgeon enhanced maneuverability and visualization. A high-definition, three-dimensional camera magnifies the surgical site tenfold, allowing for extraordinary precision. Surgeons control the robot from a remote console, translating their hand movements into highly refined surgical actions.

The vaginoplasty surgeons at NYU Langone, Dr. Rachel Bluebond-Langner and Dr. Lee Zhao, utilize the Da Vinci® SP robotic system, which offers improved depth perception, advanced image referencing, and enhanced freedom of movement compared to earlier robotic platforms. These features contribute to safer procedures and superior outcomes.

Advantages of Robotic-Assisted Peritoneal Vaginoplasty

  • Shorter Operating Time with the Single-Port System
    The single-port robotic system facilitates both surgeons, Dr. Bluebond-Langner and Dr. Zhao, working simultaneously  reducing surgery time from over 4 hours to under 2 hours while still achieving excellent vaginal depth and width. Shorter operating time minimizes risk of complication related to anesthesia and positioning.

  • Faster Recovery and Reduced Complications
    The Da Vinci® SP system’s advanced visualization and precision enable Dr. Bluebond-Langner and Dr. Zhao to work with greater accuracy, minimizing the risk of injury to surrounding tissues and enhancing safety and recovery. Because robotic surgery requires only small incisions, patients experience less surgical trauma, reduced postoperative pain, and minimal scarring. Many patients are able to resume daily activities sooner than those who undergo traditional open surgery.

    According to long-term data, patients who underwent robotic peritoneal flap vaginoplasty reported a complication rate of just 4%, significantly lower than traditional methods. Additionally, only 12% of patients opted for elective revision surgery, demonstrating a high rate of initial surgical success.

  • High Patient Satisfaction and Long-Term Stability
    In the same study, 85% of patients were followed for at least a year, with consistently positive functional and aesthetic outcomes. The vast majority maintained their vaginal depth, and those who had concerns about sexual function before surgery often saw improvement.

    Consistent vaginal depth depends on accurate dissection of the canal and available tissue for lining. The peritoneal tissue provides material that may otherwise be lacking and the robotic assistance allows for direct visualization, more precise peritoneal dissection thereby minimizing trauma and facilitating maintenance of vaginal depth over time.

For a visual guide to how robotic-assisted peritoneal flap vaginoplasty is performed at NYU, please see the animated video below. (YouTube login required.)

Robotic Peritoneal Flap Vaginoplasty - Dr. Rachel Bluebond-Langner

Robotic-assisted peritoneal flap vaginoplasty represents a major advancement in gender-affirming surgery, offering improved surgical precision, lower complication rates, enhanced aesthetic outcomes, and positive long-term results. With the ability to create a well-vascularized, full-depth vaginal canal while minimizing recovery time and scarring, this technique is a compelling option for those seeking vaginoplasty. As more long-term data becomes available, robotic-assisted peritoneal flap vaginoplasty continues to establish itself as a safe, effective, and high-quality alternative to traditional penile inversion vaginoplasty.

References

Blasdel G, Hemal K, Dubach-Reinhold C, Parker A, Amro C, Zhao LC, Bluebond-Langner R. "Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases". Ann Surg. 2025 Jan 9.


Last updated: 02/28/25