Jean-Francois Tremblay, Slawomir Marecik, Loren Schechter, John J Park, Leela M Prasad. Advocate Lutheran General Hospital
Background: Traditional male to female sex change surgery involves external genital amputation and the creation of a neovagina by penile and scrotal skin inversion. These procedures frequently fail due to neovagina obliteration or development of recto-neovaginal fistula. This study examines the potential of the robotic platform in redo pelvic surgery with special focus on gender reassignment procedures (male to female).
Material and methods: Six operations were conducted between 2013 and 2016 which involved robotic-assisted anterior pelvic dissection with resection of failed neovaginas (6) and two fistula repairs between rectum and neovagina. The sigmoid colon was used for creation of intestinal neovagina (INV) in 5 patients and the caecum in one patient.
Results: Patients were on average 45 years old with a body mass index of 27.8. Mean surgical time was 342 minutes, estimated blood loss 175 mL and length of hospital stay 7.7 days. There were no intraoperative complications. Two protective ileostomies were created in patients who had rectal fistulas and needed low rectal repair. One conversion to open surgery was necessary due to INV reach problem (caecum was used in the end). Late complications included a mild introitus skin stenosis and 2 mild INV prolapses. One revision of the colorectal anastomosis was needed for stricture. Both ileostomies were reversed 3 months after initial surgery without complications. All patients resumed satisfactory receptive intercourse via INV.
Conclusions: Use of the robotic daVinci surgical system is feasible, helpful and safe in difficult redo pelvic surgery, as seen after failed traditional gender reassignment surgery. We experienced no operative and minimal post-operative complications with excellent functional results.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79126
Program Number: P682
Presentation Session: Poster (Non CME)
Presentation Type: Poster