Robotic Applications in Gender Affirming Genital Surgery

Genitourinary reconstruction for transgender/gender non-binary (TGNB) individuals often involves perineal dissection with challenging surgical exposure. Robotic transabdominal approaches to vaginoplasty or vaginectomy allow for enhanced visualization, improved access to deep pelvic structures, and potential for new reconstructive techniques. We describe novel techniques and preliminary outcomes of robotic-assisted genital gender affirming surgery (GAS). These procedures include primary and revision peritoneal flap vaginoplasty, enteric vaginoplasty, and vaginectomy with vaginal mucosal flap and graft harvest for urethral lengthening. Further optimization of emerging techniques, assessment of long-term results, and the development of standardized outcome measures are critical future directions for robotic GAS.