Total laparoscopic sigmoid vaginoplasty

A step-by-step surgical video tutorial is presented, demonstrating the total laparoscopic sigmoid vaginoplasty procedure. It has proved to be safe and feasible, and it provides good surgical and functional results.

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Volume 106, Issue 7, Pages e22-e23

Authors:

Mark-Bram Bouman, M.D., Ph.D., F.E.S.S.M., Marlon E. Buncamper, M.D., Ph.D., F.E.S.S.M., Wouter B. van der Sluis, M.D., Ph.D., Wilhelmus J.H.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 center.

Patient(s)

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

Intervention(s)

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.

Main Outcome Measure(s)

None.

Result(s)

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.

Conclusion(s)

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.


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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