By Dr. John Henry Pang, plastic and reconstructive surgeon and Dr. Thomas Satterwhite, plastic surgeon
We are excited to begin offering a new option in genital (bottom) surgery: robotic peritoneal pull-through – or “PPT” – in 2024. We know that this procedure is generating a lot of buzz right now, which means there is also a lot of misinformation about it. While we’re very pleased to add it to Align Surgical’s services, we also want to help our patients understand exactly what it is and who it’s for, so that they can make informed choices for their bodies.
What is robotic peritoneal pull-through vaginoplasty?
PPT is a procedure in which the abdominal lining, called the peritoneum, is pulled down internally to help construct a vagina. This technique originated in the 1970s by reconstructive gynecologists seeking to enable cis women born without a fully formed vaginal canal (a congenital condition called Müllerian agenesis, or MRKH syndrome) to be able to have penetrative intercourse. In recent years, plastic surgeons have applied these concepts and techniques to constructing a vaginal canal for trans and gender diverse individuals. This surgery usually involves two surgeons, one of whom works robotically.
How is PPT different from other vaginoplasty procedures?
Traditional “penile inversion” vaginoplasty uses the patient’s own genital tissues to create an external vulva (labia and clitoris/clitoral hood) and an internal vaginal canal. All these steps are performed by a single surgeon in the perineal space between the legs.
In robotic vaginoplasty, there are two surgeons: the robotic surgeon works via the patient’s abdomen, lifting the peritoneal flap (the lining of the abdominal cavity) internally to create a vaginal canal. Simultaneously, the other surgeon creates the external vulva from existing genital tissues in the perineal space.
The outcomes for both types of vaginoplasty are the same in terms of external aesthetics, the ability to engage in penetrative intercourse and the ability to achieve orgasm. Robotic vaginoplasty is a more complex surgery and offers fewer follow-up options should adjustments be required post-operation.
Who is PPT for?
Robotic PPT vaginoplasty is an excellent option for transwomen, non-binary and gender diverse individuals who want a vaginoplasty or a patient-tailored genital procedure but who either do not have enough genital tissue to create a vaginal canal (sometimes due to the use of puberty blockers) or for whom a traditional vaginoplasty has not produced satisfactory results, such as in the case of stenosis or fistula.
What are the benefits and risks?
Robotic surgery is safe, effective, and can reduce the size of incisions (and therefore scarring) when operating in the abdomen.
The robotic peritoneal pull-through technique is an excellent revisional surgery option for patients who are experiencing issues following a traditional vaginoplasty. Any type of vaginoplasty procedure is a surgery that carries the risk of complications. Using robotic vaginoplasty as the primary, or first, genital surgery can significantly limit the patient’s options for any necessary secondary reconstructive procedures.
Generally, my colleagues and I recommend that patients begin with the least invasive procedure, so robotic vaginoplasty may not be the best first choice for everyone.
Setting the record straight on PPT
There is a lot of misinformation circulating about robotic PPT vaginoplasty, so our goal here is to educate patients with the facts they need to make informed decisions for their body.
For example, the term “robotic” may lead people to perceive this as an easier or more “advanced” procedure that is superior to traditional vaginoplasties. It is not – it is one of many tools surgeons can use to help patients achieve their goals.
There are also misperceptions about the peritoneal tissue providing a naturally “self-lubricating” vaginal canal, which is not accurate. Peritoneal tissue does not contain mucus-producing cells and thus is not self-lubricating.
Robotic vaginoplasty is simply one more surgical option available to our patients. It is not a replacement for traditional penile-inversion vaginoplasty.
When will robotic PPT vaginoplasty be available at Align Surgical?
We are offering consultations now and booking procedures beginning in mid-2024.
As with all surgeries, we strongly encourage patients to begin by scheduling a consultation with a surgeon at Align so that we can fully understand your goals and physical needs, provide all the facts and work together with you to identify the best option for your body and your goals.