Total Laparoscopic Sigmoid Vaginoplasty

Authors: Mark-Bram Bouman, M.D., Marlon E. Buncamper, M.D., Wouter B. van der Sluis, M.D., Wilhelmus J. Meijerink, M.D. Ph.D. Abstract: Objective To demonstrate step-by-step our technique for total laparoscopic sigmoid vaginoplasty. Design: Surgical video tutorial. Setting: Academic Medical Centre. Patients: Transgender women with penile hypoplasia or with a failed primary vaginoplasty and biological women with either acquired or congenital absence of a functional vagina. Interventions: 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 a 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 gave consent for the use of this video in this article. Main Outcome Measures: None. Results: If laparoscopic intestinal vaginoplasty is performed by an experienced team, with the right medical infrastructure and laparoscopic equipment, successful and reproducible results can be achieved. Since 2008 our group performed over 70 cases with good functional results. Potential complications of this procedure comprise bowel anastomosis leakage or anastomotic stenosis. 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 results. In selected cases it is indicated for primary vaginoplasty as well as for revision vaginoplasty.