(155) Comparison of 2 Methods for Robotic Assisted Gender Affirming Vaginoplasty; 2 Year Follow-up in Korea

Abstract Introduction Robotic assisted gender affirming surgery has three methods using a sigmoid colon or a method using a peritoneum or inverted penile skin. Although sigmoid vaginoplasty requires bowel resection, but it is the most ideal technique to create neovagina. However, the method using colon is more invasive than other methods. Objective We would like to compare the sigmoid vaginoplasty and peritoneal method followed for 2 year. Methods Department of urology, general surgery, and plastic surgery were performed this surgery as a team. A neovaginal canal was dissected between the prostate and rectum and widened using dildo. And sigmoid colon or peritoneum was harvested and approximated to neovaginal apex. A total of 22 transgender women underwent gender affirming vaginoplasty between January 2021 and May 2023. We retrospectively reviewed data for patients with a minimum 6 mo of follow-up. Patient characteristics, perioperative data and clinical outcomes were evaluated. Results A total of 11 patients with sigmoid colon and 11 patients with peritoneum were enrolled. The mean age was 27.54 (range 18-55) yr and 24.7 (22-29 yr). The total operation time was 686 min (range 540-875) with sigmoid vaginoplasty and 479.5 min (425-630) with peritoneal method and they were significantly different (p=0.044). There was a reoperation due to bowel perforation in one case as a severe complication in sigmoid method. However, there were no complications such as vaginal stenosis, urinary retention, or rectovaginal fistula in both methods. There was no statistical difference in the total number of hospital days, but there was a statistical difference in the time to initiation of the diet (p0.001). There was no dyspareunia and all patients were able to have sexual intercourse. Conclusions Compared to the colon method, the peritoneal method took less time to operate, started diet more quickly, and had fewer bowel problems. Until now, there has been no difference in postoperative vaginal stenosis and satisfaction with sexual intercourse, but it is necessary to pay attention to the results of long term follow-up in the future. Disclosure No