Vaginoplasty is a key component of gender-affirming surgery for transgender women. While penile inversion vaginoplasty remains the most common technique, patients with insufficient penile and scrotal tissue require alternative approaches. Robotic-assisted peritoneal vaginoplasty (RAPV) is an emerging technique that utilizes peritoneal tissue for neovaginal construction, offering advantages such as self-lubrication and reduced graft contraction. Here, we present the first documented case of RAPV performed in Asia.

A 29-year-old transgender woman with gender dysphoria sought vaginoplasty. She underwent RAPV using a Da Vinci Xi robotic system. The peritoneal flap was harvested via transabdominal robotic-assisted dissection, followed by neovaginal canal creation through the perineal approach. The peritoneal flap was then advanced and secured to form the vaginal lining. Operative time, intraoperative complications, and early postoperative outcomes were assessed.

The procedure was completed successfully without intraoperative complications. The total operative time was approximately 7 hours, with minimal blood loss. The patient had an uneventful postoperative recovery, with good vaginal depth and width during follow-up.

Robotic-assisted peritoneal vaginoplasty represents a viable and innovative option for transgender women with insufficient genital tissue for traditional vaginoplasty. As the first reported case in Asia, RAPV demonstrates promising feasibility in gender-affirming surgery, warranting further study and adoption in specialized centers.