Robotics in genital gender-affirming surgery

Abstract

Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia. Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis, thereby facilitating certain procedures. In this scoping review, we will discuss the developing role of the robot in genital affirming genital surgery. Indications, techniques, and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.

Keywords

Robotic surgery / gender affirming surgery / vaginoplasty / peritoneal vaginoplasty / intestinal vaginoplasty / metoidioplasty / colpectomy / vaginectomy / phalloplasty

References

[1] Coleman E,Bouman WP.Standards of care for the health of transgender and gender diverse people, version 8.Int J Transgend Health2022;23:S1-259

[2] Jiang DD,Burchill L,Dugi D 3rd.Implementation of a Pelvic floor physical therapy program for transgender women undergoing gender-affirming vaginoplasty.Obstet Gynecol2019;133:1003-11

[3] Muaddi H,Choi WJ.Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews.Ann Surg2021;273:467-73

[4] Wee IJY,Ngu JC.A systematic review of the true benefit of robotic surgery: Ergonomics.Int J Med Robot2020;16:e2113

[5] Rizzo KR,Ford B,Ofstun E.Status of robotic assisted surgery (RAS) and the effects of Coronavirus (COVID-19) on RAS in the department of defense (DoD).J Robot Surg2023;17:413-7 PMCID:PMC9225798

[6] Khan MTA,Lee CS.Systematic review of academic robotic surgery curricula.J Robot Surg2023;17:719-43

[7] Flynn J,Kong JCH,Warrier SK.The learning curve in robotic colorectal surgery compared with laparoscopic colorectal surgery: a systematic review.Colorectal Dis2021;23:2806-20

[8] Lin CY,Chen MC.Learning curve and surgical outcome of robotic assisted colorectal surgery with ERAS program.Sci Rep2022;12:20566 PMCID:PMC9709162

[9] Peters BR,Butler C,Dy GW.Robotic peritoneal flap vs. perineal penile inversion techniques for gender-affirming vaginoplasty.Curr Urol Rep2022;23:211-8

[10] Jacoby A,Granieri MA.Robotic davydov peritoneal flap vaginoplasty for augmentation of vaginal depth in feminizing vaginoplasty.J Urol2019;201:1171-6

[11] Jun MS,Zhao LC.Penile inversion vaginoplasty with robotically assisted peritoneal flaps.Plast Reconstr Surg2021;148:439-42 PMCID:PMC10538597

[12] Solass W,Struller F.Functional vascular anatomy of the peritoneum in health and disease.Pleura Peritoneum2016;1:145-58 PMCID:PMC6328070

[13] Dy GW,Blasdel G,Zhao LC.Outcomes of gender affirming peritoneal flap vaginoplasty using the da vinci single port versus xi robotic systems.Eur Urol2021;79:676-83

[14] Claes KEY,D'Arpa S,Monstrey SJ.Male-to-female gender confirmation surgery: intestinal vaginoplasty.Clin Plast Surg2018;45:351-60

[15] Safiejko K,Koselak M.Robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients.Cancers2021;14:180 PMCID:PMC8750860

[16] Charalambides M,Jennings T.A systematic review of the literature assessing operative blood loss and postoperative outcomes after colorectal surgery.Int J Colorectal Dis2022;37:47-69

[17] Negenborn VL,Meijerink WJHJ.Lethal necrotizing cellulitis caused by ESBL-producing E. coli after laparoscopic intestinal vaginoplasty.J Pediatr Adolesc Gynecol2017;30:e19-21

[18] Bouman MB,Buncamper ME,van Bodegraven AA.Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.J Sex Med2014;11:1835-47

[19] van der Sluis WB,Meijerink WJHJ.Laparoscopic intestinal vaginoplasty in transgender women: an update on surgical indications, operative technique, perioperative care, and short- and long-term postoperative issues.Urol Clin North Am2019;46:527-39

[20] van der Sluis WB,de Boer NK.Long-term follow-up of transgender women after secondary intestinal vaginoplasty.J Sex Med2016;13:702-10

[21] Salibian AA,Kuzon WM.Vaginal canal reconstruction in penile inversion vaginoplasty with flaps, peritoneum, or skin grafts: where is the evidence?.Plast Reconstr Surg2021;147:634e-43e

[22] Parker A,Blasdel G,Zhao LC.Mending the gap: alloderm as a safe and effective option for vaginal canal lining in revision robotic assisted gender affirming peritoneal flap vaginoplasty.Urology2023;173:204-8

[23] Dy GW,Shakir NA,Zhao LC.Robotic peritoneal flap revision of gender affirming vaginoplasty: a novel technique for treating neovaginal stenosis.Urology2021;154:308-14

[24] American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, The Society of Gynecologic Surgeons. Robot-assisted surgery for noncancerous gynecologic conditions: ACOG COMMITTEE OPINION, number 810.Obstet Gynecol2020;136:e22-30

[25] Sarlos D,Stevanovic N,Schär G.Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial.Obstet Gynecol2012;120:604-11

[26] Grant JM,Tanis JJ. National transgender discrimination survey: full report. Available from: https://transequality.org/issues/resources/national-transgender-discrimination-survey-full-report [Last accessed on 27 Oct 2023]

[27] Ferrando CA,Pollard R.Preoperative pain symptoms and the incidence of endometriosis in transgender men undergoing hysterectomy for gender affirmation.J Minim Invasive Gynecol2021;28:1579-84

[28] Tissot M,Faller E,Akladios C.Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases.J Gynecol Obstet Hum Reprod2017;46:647-50

[29] Al-Tamimi M,van der Sluis WB.Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery.J Urol2018;200:1315-22

[30] Cusimano MC,Dossa F.Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications.Am J Obstet Gynecol2019;221:410-28.e19

[31] Bogliolo S,Babilonti L,Nappi RE.Robotic single site hysterectomy with bilateral salpingo-oophorectomy in female to male transsexualism.J Sex Med2014;11:313

[32] Weyers S,Monstrey S.Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals.Gynecol Surg2006;3:190-4.

[33] Jun MS,Blasdel G.Robotic-assisted vaginectomy during staged gender-affirming penile reconstruction surgery: technique and outcomes.Urology2021;152:74-8

[34] Groenman F,Huirne J,Trum H.Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study.Surg Endosc2017;31:3363-9 PMCID:PMC5501901