Presentation Authors: Nicholas Chakiryan*, Daniel Dugi, Kamran Sajadi, Portland, OR
Introduction: We encountered a 29 year old patient with congenital androgen insensitivty syndrome who had previously undergone a McIndoe vaginoplasty with neovagina. He later began identifying as male and desired a gender-affirming colpectomy and colpocleisis at the time of his second stage phalloplasty procedure. Review of the literature did not reveal any previous report describing the complete surgical removal of a McIndoe neovagina. Our objective is to document the technique and feasibility of colpectomy and colpocleisis of a McIndoe neovagina.
Methods: The procedure was undertaken in August 2018 at Oregon Health & Science University. At our institution, colpectomy and colpocleisis is performed at the time of definitive trans-male gender-affirming surgery. The technique utilized for removal of the McIndoe neovagina was essentially identical to that typically performed for removal of a native vagina. The patient is positioned in lithotomy. The specimen is dissected sharply. Great care is taken to avoid surrounding structures. The wound is closed with a series of purse string 2-0 Maxon sutures.
Results: There were no complications from the procedure. A relatively avascular plane was found between the neovaginal epithelium and the underlying tissue. The specimen was removed en-bloc. No entry was made into the peritoneum at the neovaginal apex. Estimated blood loss was 100mL. Total operative time for this portion of the procedure was 77 minutes. The patient had an uneventful postoperative course.
Conclusions: Gender-affirming colpectomy and colpocleisis of a McIndoe neovagina, in our experience, is both feasible and safe.