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Oliver et al. Plast Aesthet Res. 2025;12:19 https://dx.doi.org/10.20517/2347-9264.2025.11 Page 3 of 16

Table 1. Studies of gender-affirming robotic-assisted vaginoplasty
Average Average
Author, Neovaginal dimensions
year Technique Study design No. of patients follow-up operative (cm) Complications (n, %)
(months)
time (mins)
Jacoby Primary Case series 41 3.7 ± 2.5 SD 262 ± 35 Depth: 14.2 ± 0.7 SD, Wound complications: granulation tissue and delayed wound
et al. (peritoneal flap + penile Width: 3.6 ± 0.2 SD healing in (20%)
2019 [5] inversion with scrotal
skin graft)
Dy et al. Primary Case series 100 11.9 Multi-port: Multi-port: Depth: 13.6 Blood transfusion: 6 (6%), rectovaginal fistula: 1 (1%)
[12]
2021 (peritoneal flap + penile (47 multi-port, (range 6.0- 254 (range 9.7-14.5), Bowel obstruction: 2 (2%), pelvic abscess: 1 (1%) vaginal stenosis: 7
inversion with ± scrotal 53 single-port) 25.4) Single port: Width: 3.7 (range 2.9-3.8) (7%), reoperation 13: (13%)
skin graft) 220
Single port: Depth: 14.1 (range
9.7-14.5),
Width: 3.7 (range 3.5-3.8)
Robinson Primary Retrospective chart 274 11.9 180 - Intra-abdominal complications: 6 (2.2%) - hematoma evacuation: 1
et al. (peritoneal flap + penile review (range 0.6- (range 132- (0.4%), abscess drainage: 2 (0.7%), bowel obstruction: 1 (0.4%),
2022 [7] inversion with ± scrotal 37.9) 251) incarcerated internal hernia: 2 (0.7%)
skin graft)
Morelli Primary Case series 8 - 360 ± 90 - None
et al. (single peritoneal flap +
[9]
2022 penile inversion with
scrotal skin graft
Blasdel Primary Retrospective case- 92 12 206 (IQR 165- Depth 14.5 (IQR 13.3 to 14.5), Bowel obstruction (secondary to intestinal herniation through
et al. (peritoneal flap + penile control analysis (43 with peno- (IQR 6-5.6) 251), diameter 3.8 (IQR 3.8 to 3.8) peritoneal flap): 1 (1.1%), rectovaginal fistula: 1 (1.1%), neovaginal
[13]
2023 inversion with ± scrotal (comparison of scrotal Hypoplasia - no significant difference stenosis: 10 (11%)
skin graft) patients with peno- hypoplasia, 49 group 204 between peno-scrotal
scrotal hypoplasia vs. controls without) (IQR 166-237) hypoplasia vs. without
controls without) Control 212
(IQR 165-253)
Blasdel Primary Retrospective cohort 500 14.8 - Depth 14.5 (IQR 13.3 to 14.5), Rectal injury: 1 (0.2%), rectovaginal fistula: 1 (0.2%), blood
et al. (peritoneal flap + penile study (IQR 11.9-28) diameter 3.8 (IQR 3.8 to 3.8) transfusion: 18 (3.6%), reoperation for hemostasis: 5 (1%), abscess
[8]
2025 inversion with scrotal drainage: 4 (0.8%), peritoneal flap defect: 2 (0.4%), meatal
skin graft) stricture: 2 (0.4%), prostatic stricture with urethra-vaginal fistula: 1
(0.2%), bowel obstruction: 1 (0.2%), vaginal depth revision: 3
(0.6%), UTI: 39 (7.8%), LUTS: 25 (5%), UUI: 31 (6.2%)
Del Corral Primary Case series 6 8 263 Depth: 17.8 Reoperation for: flap vascularity confirmation: 1 (16.7%), evacuation
et al. (robotic-assisted (range 1-14) (range 236- Width: 3.3 of groin hematoma: 1 (16.7%), repair of ventral hernia: 1 (16.7%),
[19]
2024 jejunal free flap + penile 296) repair of dehiscence between jejunal flap and neovaginal introitus: 1
inversion with scrotal (16.7%), benign polyp removal: 1 (16.7%)
skin graft)
Acar et al. Mixed Case series 11 2.6 ± 2.8 SD 267.2 ± 85.9 Depth: 13.9 ± 0.5 SD Delayed wound healing: 2 (18%), VTE: 1 (9%), blood transfusion: 1
[11]
2020 (Primary - peritoneal (9%), reoperation for urethra-neovaginal fistula: 1 (9%), 30-day re-
flap + penile inversion admission: 2 (18%)
with ± scrotal skin graft;