- Email: [email protected]
Total laparoscopic sigmoid vaginoplasty
VIDEO
Total laparoscopic sigmoid vaginoplasty Mark-Bram Bouman, M.D., Ph.D., F.E.S.S.M.,a,b,c,d Marlon E. Buncamper, M.D., Ph.D., F.E.S.S.M.,a,b,c,d Wouter B. van der Sluis, M.D., Ph.D.,b,c and Wilhelmus J. H. J. Meijerink, M.D., Ph.D.a,c,d,e a Gender Surgery Amsterdam, VU University Medical Center; b Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center; c EMGO+ Institute for Health and Care Research, VU University Medical Center; d Center of Expertise on Gender Dysphoria, VU University Medical Center; and e Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, the Netherlands
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. (Fertil SterilÒ 2016;-:-–-. Ó2016 by American Society for Reproductive Medicine.) Key Words: Gender dysphoria, reconstructive surgical procedures, laparoscopic surgery, sex reassignment procedures, sigmoid vaginoplasty, surgical technique Discuss: You can discuss this article with its authors and with other ASRM members at
NOW AVAILABLE ON YOUTUBE https://youtu.be/pMKYSv2ZsjA
2.
SUGGESTED READING
3.
1.
Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revi-
sited: a review of surgical techniques, complications, and sexual function. J Sex Med 2014;11:1835–47. Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases. J Sex Med 2011;8: 3487–94. Karateke A, Haliloglu B, Parlak O, Cam C, Coksuer H. Intestinal vaginoplasty: seven years’ experience of a tertiary center. Fertil Steril 2010;94:2312–5.
4. Zhong CX, Wu JX, Liang JX, Wu QH. Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis. Chin Med J (Engl) 2012;125:203–8. 5. Kisku S, Varghese L, Kekre A, Sen S, Karl S, Mathai J, et al. Bowel vaginoplasty in children and young women: an institutional experience with 55 patients. Int Urogynecol J 2015;26: 1441–8. 6. Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam J. Long-term
Received February 21, 2016; accepted August 25, 2016. M.-B.B. has nothing to disclose. M.E.B. has nothing to disclose. W.B.v.d.S. has nothing to disclose. W.J.H.J.M. has nothing to disclose. Reprint requests: Mark-Bram Bouman, M.D., Ph.D., F.E.S.S.M., Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands (E-mail: [email protected]). Fertility and Sterility® Vol. -, No. -, - 2016 0015-0282/$36.00 Copyright ©2016 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2016.08.049 VOL. - NO. - / - 2016
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outcomes of rectosigmoid neocolporrhaphy in male-to-female gender reassignment surgery. Plast Reconstr Surg 2015;136:386–94. Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, Buncamper ME, Kreukels BP, Meijerink WJ, et al. Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med 2016;13:1438–44. van der Sluis WB, Bouman MB, Meijerink WJ, Elfering L, Mullender MG, de Boer NK, et al. Diversion neovaginitis after sigmoid
vaginoplasty: endoscopic and clinical characteristics. Fertil Steril 2016; 105:834–9.e1. € 9. van der Sluis WB, Verweij SP, Ozer M, Meijerink WJ, Bouman MB. Total laparoscopic intestinal vaginoplasty as neovaginal reconstruction in an HIVseropositive transgender woman. Int J STD AIDS 2016;27:684–6. 10. Bouman MB, van der Sluis WB, Nurmohamed SA, van Tellingen A, Meijerink WJ. Total laparoscopic colocolpopoiesis in a kidney transplant recipient with Frasier syndrome. Female Pelvic Med Reconstr Surg 2016; 22:e11–3.
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Total laparoscopic sigmoid vaginoplasty Mark-Bram Bouman, M.D., Ph.D., F.E.S.S.M.,a,b,c,d Marlon E. Buncamper, M.D., Ph.D., F.E.S.S.M.,a,b,c,d Wouter B. van der Sluis, M.D., Ph.D.,b,c and Wilhelmus J. H. J. Meijerink, M.D., Ph.D.a,c,d,e a Gender Surgery Amsterdam, VU University Medical Center; b Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center; c EMGO+ Institute for Health and Care Research, VU University Medical Center; d Center of Expertise on Gender Dysphoria, VU University Medical Center; and e Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, the Netherlands
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. (Fertil SterilÒ 2016;-:-–-. Ó2016 by American Society for Reproductive Medicine.) Key Words: Gender dysphoria, reconstructive surgical procedures, laparoscopic surgery, sex reassignment procedures, sigmoid vaginoplasty, surgical technique Discuss: You can discuss this article with its authors and with other ASRM members at
NOW AVAILABLE ON YOUTUBE https://youtu.be/pMKYSv2ZsjA
2.
SUGGESTED READING
3.
1.
Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revi-
sited: a review of surgical techniques, complications, and sexual function. J Sex Med 2014;11:1835–47. Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases. J Sex Med 2011;8: 3487–94. Karateke A, Haliloglu B, Parlak O, Cam C, Coksuer H. Intestinal vaginoplasty: seven years’ experience of a tertiary center. Fertil Steril 2010;94:2312–5.
4. Zhong CX, Wu JX, Liang JX, Wu QH. Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis. Chin Med J (Engl) 2012;125:203–8. 5. Kisku S, Varghese L, Kekre A, Sen S, Karl S, Mathai J, et al. Bowel vaginoplasty in children and young women: an institutional experience with 55 patients. Int Urogynecol J 2015;26: 1441–8. 6. Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam J. Long-term
Received February 21, 2016; accepted August 25, 2016. M.-B.B. has nothing to disclose. M.E.B. has nothing to disclose. W.B.v.d.S. has nothing to disclose. W.J.H.J.M. has nothing to disclose. Reprint requests: Mark-Bram Bouman, M.D., Ph.D., F.E.S.S.M., Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands (E-mail: [email protected]). Fertility and Sterility® Vol. -, No. -, - 2016 0015-0282/$36.00 Copyright ©2016 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2016.08.049 VOL. - NO. - / - 2016
e1
VIDEO
7.
8.
e2
outcomes of rectosigmoid neocolporrhaphy in male-to-female gender reassignment surgery. Plast Reconstr Surg 2015;136:386–94. Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, Buncamper ME, Kreukels BP, Meijerink WJ, et al. Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med 2016;13:1438–44. van der Sluis WB, Bouman MB, Meijerink WJ, Elfering L, Mullender MG, de Boer NK, et al. Diversion neovaginitis after sigmoid
vaginoplasty: endoscopic and clinical characteristics. Fertil Steril 2016; 105:834–9.e1. € 9. van der Sluis WB, Verweij SP, Ozer M, Meijerink WJ, Bouman MB. Total laparoscopic intestinal vaginoplasty as neovaginal reconstruction in an HIVseropositive transgender woman. Int J STD AIDS 2016;27:684–6. 10. Bouman MB, van der Sluis WB, Nurmohamed SA, van Tellingen A, Meijerink WJ. Total laparoscopic colocolpopoiesis in a kidney transplant recipient with Frasier syndrome. Female Pelvic Med Reconstr Surg 2016; 22:e11–3.
VOL. - NO. - / - 2016