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Page 14 of 16 Oliver et al. Plast Aesthet Res. 2025;12:19 https://dx.doi.org/10.20517/2347-9264.2025.11

Introducing robotic techniques into GAS may attract a different cadre of surgeons working in a
multidisciplinary team setting, which is required in a field where surgical expertise is limited to a few
surgeons in each country. In a survey among plastic surgeons and trainees, 89.7% of respondents expressed
support for incorporating robotic surgery into future plastic surgery residency training; 43.6% identified
microsurgery and 40.7% flap tissue harvest as the most beneficial areas for adoption . More studies using
[47]
standardized measures of satisfaction and functional outcomes are welcomed to strengthen the evidence
base.

In the transfeminine population, the current literature suggests both primary and rRA-GPV are safe and
can provide good outcomes in terms of neovaginal depth, with a comparable rate of complications to
standard techniques. In addition, it provides an option for vaginoplasty in patients unsuitable for PIV or
“standard” skin techniques. The visibility and manoeuvrability with robotic systems is a particular
advantage in patients in the salvage setting, where dissecting between the stenosed rectum and bladder via
an open or laparoscopic approach carries a significant risk of rectal injury. The current evidence for robotic
intestinal segment vaginoplasty is limited, but it shows considerable potential.

In the transmasculine population, robotic-assisted approaches to vaginectomy overcome challenges
commonly seen in this cohort, most notably improved access and working space in a narrow, atrophied
vagina. While there are no studies reporting outcomes of ablative colpocleisis via a robotic transabdominal
approach, the small number of studies regarding robotic-assisted total vaginectomy suggest this is feasible
and safe, with a low risk of major complications. Based on the current literature, robotic transabdominal
hysterectomy ± BSO in the transmasculine population appears safe and is associated with low blood loss,
low complication rate, and reasonable operative times.

The published evidence for robotic surgery applications to phalloplasty is very limited, and thus, early
conclusions can only really be extrapolated from evidence from non-GAS robotic microsurgery and robotic
flap harvesting in other reconstructive surgeries. Current evidence suggests that operative time is longer for
both flap harvesting and microsurgery using a robotic approach. Potential advantages could include shorter
learning curves for the less experienced surgeon, tremor reduction, shortened recovery and hospital stay for
patients, and lower complication rates.

Further large, prospective studies are needed to fully demonstrate the applications and assess outcomes of
robotic-assisted surgery in genital GAS, including direct comparisons with traditional techniques.

DECLARATIONS
Authors’ contributions
Literature search and analysis: Oliver R, Kanthabalan A, Tinajero JD
Writing-review: Oliver R, Kanthabalan A, Tinajero JD, Rashid T, Ahmed J, Flint R, Rose V, Di Taranto G

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.