V13-03 ROBOT-ASSISTED LAPAROSCOPIC ABDOMINAL SACROCOLPOPEXY OF NEOVAGINA USING DA VINCI SP

Abstract

INTRODUCTION AND OBJECTIVE: Robot-assisted laparoscopic abdominal sacrocolpopexy is an established treatment for repair of vaginal prolapse. While prolapse of the neovagina is a potential complication of penile inversion vaginoplasty reports of management of these cases is scarce. As gender affirmation surgery increases in the United States so too will management of this condition. We present a repair of neovaginal prolapse using the newest robotic system, da Vinci SP. METHODS: The patient is a 72 year old natal male affirmed female with gender dysphoria who present with vaginal prolapse. She had a penile inversion vaginoplasty five years prior with development of apical laxity. Robot-assisted laparoscopic abdominal sacrocolpopexy of the neovagina was performed using the da Vinci SP system. The SP robotic trocar was placed in a 2.7cm supraumbilical incision and a 10mm assistant port was inserted in the left lower quadrant. The patient was placed in steep trendelenberg and a Y-shaped polypropylene mesh was secured to the neovagina and tensioned to the sacral promontory. RESULTS: The procedure was performed without complication. On postoperative day one, vaginal packing and foley catheter were removed, she passed trial of void and was discharged. She was seen in clinic doing well without complaint and with excellent surgical results. CONCLUSIONS: Robot-assisted abdominal sacrocolpopexy may be performed for prolapse of neovagina. The da Vinci SP robotic system is suitable for this approach. Further data are needed to assess durability of outcomes of this surgery for this patient population.