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Introduction

Sigmoid Colon and Ileum have been described as alternative sources of graft-tissue for transgender (M to F) women undergoing gender-affirming vaginoplasty surgery to create a neovaginal canal de novo. The use of Right Colon has never been described for this purpose. Also, to date, there has been no description in the literature about how to perform salvage vaginoplasty (for vaginal canal replacement) in general, for vaginal canal replacement in either transgender or cisgender women.

Objectives

We describe: 1. A novel trans-pelvic and abdominal-laparoscopic surgical technique developed by our group for both de novo creation, and replacement, of a vaginal canal (vaginoplasty) using an intact segment of Right Ascending Colon as a pedicle-flap; 2. Proposed indications for use of intestine (versus alternative graft options) for creation of a vaginal canal in transgender and cisgender women; 3. Constraints specific to the surgical site, human anatomic data, and practical considerations- which all support why this technique is superior to previously described intestinal vaginoplasty techniques using Sigmoid Colon and Ileum; 4. Key elements of the surgical set-up and surgical approach for an inter-disciplinary surgical team consisting of a reconstructive urologist (performing the transpelvic vaginal construction) and a colorectal surgery team (performing the colon-graft harvest); 5. We describe two novel surgical devices designed specifically for intestinal vaginoplasty; and 6. We describe refinements to our technique to minimize risk of complications associated with intestinal vaginoplasty.

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