Laproscopic peritoneal vaginoplasty

[josie76]

I've been researching this technic in general. It has been used much more commonly in genetic females with MRKH syndrome (Mullerian Agenasis) and 46XY patients with complete or near complete AIS (androgen insensitivity syndrome).

PAIS patients usually require removal of testes from the labia and a clitoral reduction. So basically a GCS with less tissue removal.

MRKH patients often require some cosmetic labiaplasty repairs as do CAIS patients.

Point being its been done for a very long time now, just not for transgender patients. A number of doctors perform this procedure. It's also called an "Improved Laproscopic Davydov Method". Davydov was a Russian surgeon who first described and performed the open abdominal incision surgery.
Drs Milkos and Moore here in the US developed their own laproscopic version as did Dr. Mahtre of the University Medical School in Mumbia, India. Dr. Mahtre has published long term studies with patient results and sexual satisfaction including a survey of the patients partners.

Study listing:


Arch Gynecol Obstet. 2014 Oct;290(4):691-6. doi: 10.1007/s00404-014-3250-4. Epub 2014 May 20.
Comparison of improved laparoscopic peritoneal vaginoplasty and gasless laparoscopic ileal vaginoplasty in treatment of androgen insensitivity syndrome.
Huang Z1, Liu P, Luo
AIS patients
Included gonadal resection and genital plastic surgery
Peritoneal method: OR time 55-105 minutes, blood loss 5-30 ml
Ileal method: OR time 155-215 minutes, blood loss 20-80 ml

Journal Human Reproductive Sci. 2014 Jul-Sep; 7(3): 181–186.
MRKH patients
doi:  10.4103/0974-1208.142478
PMCID: PMC4229793
PMID: 25395743
New laparoscopic peritoneal pull-through vaginoplasty technique
Pravin Mhatre,1,2,3 Jyoti Mhatre,2,3 and  Rakhi Sahu4


J Gynecol Obstet Biol Reprod (Paris). 2014 Jun;43(6):470-3. doi: 10.1016/j.jgyn.2013.01.006. Epub 2013 Mar 9.
[Vaginoplasty from peritoneal tube of Douglas' poutch for androgen insensitivity syndrome (two case reports)].
[Article in French]
Ait Sakel A1, Asseban M2, Kallat A2, Elsayegh H2, Iken A2, Nouini Y2, Benslimane L2, Faik M2.


Dr. John Milkos MD and Dr. Robert Moore DO
MRKH-surgeons.com
Beverly Hills, Atlanta, Dubai


I am on the waiting list for the transsexual GCS procedure in Mumbia when it becomes available. It was done as a pilot study so I guess they are waiting on patient results before the hospital/medical school staff make it fully available. A company run by two trans women there will offer the procedure. They actually act as facilitators providing all of the needed appointments and room / board with in house recovery care. It's a pretty in depth idea, as they cater to the medial tourism of India. They worked with doctors there to get the pilot study going. This included consultation from Dr. Mahtre and from what I have read the actual Laproscopic peritoneal vaginoplasty portion was performed by one of his former gynourology students. Then other plastic surgeons did the external work making it all happen in one procedure.

One of the previous studies I found interesting was on CAIS patients. The in surgery time max was less than 2 hours which included some cosmetic work and gonadal resection.

I'm pretty excited about this method. Especially the lack of dilation need after healing.

[TonyaW]

Is this same of similar to the procedure
DrJess Ting is using?  Is anyone else in the US doing these?

Sent from my SM-G930T using Tapatalk

[josie76]

Dr. Ting did something completely different. Dr. Ting still used penile inversion. But he took scrotal peritoneal type tissue out of the body, then reattached it to the inside of the inverted penile skin. His idea was to gain the self lubricating and non adhearing properties of the peritoneal tissues. This however still requires the full penile inversion with the need to stretch the skin to pull the penile skin down to the vaginal position. This is often the cause of issues like urethral position problems that require subsequent follow up revision surgery.

This version they pull down abdominal peritoneum lining which in a cis male sits the same as an MKRH female. They grab the peritoneum pull it down and form a cavity. Stitch it to the exterior skin and close the neovaginal canal and the peritoneal pouch leaving them connected. This means the neovagina is anchored in the center of the body. In penial inversion, the doctor sutures the neovagina to one of the ischial-sacral ligaments so actually pulling it to one side slightly.

Basically this procedure heal quicker and after healing requires no dialation to keep depth. What has been done for transwomen in the Indian trial study did not need any penile inversion. The neo-clitoris is set directly down and the body's natural hood like structures are used. The urethra when positioned correctly stays there and no patient has reported any urine stream issues. The peritoneal tissues themselves regenerate quickly inside of the body, healing much faster than skin grafting or skin flaps do. Peritoneal tissue also has epidural like cells on its outer layers. These cells will form a skin like lining in time in the neovagina appearing identicle to natal vaginial lining while continueing to allow natural secretions through it. Dr. Mahtre called these cells "progenetor cells" because of how they make the lining natal like.

One illustration from a peer study review of the basic procedure for MKRH and CAIS patients.

Steps-of-peritoneal-vaginoplasty-Used-with-permission-of-Xochitl-Vinaja-2017-Color



Drs. John Milkos MD and Robert Moore DO, perform this surgery as their main practice here in the US but I do not think they have ever combined it with full external genital reconstruction.

[Doreen]

I've seen where they do that for CAIS, and MRKH gals.  They still do have some issues too, but of a different type.  Pretty sure they still have to dilate though.. even cis women can experience vaginismus, drying, painful sex, etc.  Basically if you don't lose it you lose it scenario.

Still it looks more promising. 

[josie76]

I've seen where they do that for CAIS, and MRKH gals.  They still do have some issues too, but of a different type.  Pretty sure they still have to dilate though.. even cis women can experience vaginismus, drying, painful sex, etc.  Basically if you don't lose it you lose it scenario.

Still it looks more promising. 

Yes I think it's more of an occasional use will keep it up without dialating. 
Pretty much every time this has been done is MRKH or CAIS but I did see one study of a pair of sisters with AIS. However not complete AIS but a close form. They had decended testes in the labia area that were removed and clitoral shortening as they had small phalluses. The study described them as having labia with scrotal like pockets with the testes inside.

[Complete]

This sounds seriously state of the art. I like it! I had my P I upgraded in '86 using peritoneal tissue from my sigmoid colon. I have regular sex and have not dialated in over 30 years. This sounds better though because there is no neural connections with the colon. Hence, all the advatages w/o the disadvantages. 😃😀😃😆

[Stella Alexis]

Do you know if having an orchidectomy before this procedure gives any complications?

And can you send me a PM with the contact details in India?

[josie76]

Do you know if having an orchidectomy before this procedure gives any complications?

And can you send me a PM with the contact details in India?

I PM'd you with more details of who I have contacted there. Also no issues with prior orchiectomy. I have had one myself. They don't actually need all of the extra skin for these procedures.