(179) TUBULARIZED AUGMENTED PERITONEAL CAP (TAPCAP) VAGINOPLASTY
Authors: Mishra K , Sellke N , Gupta S 
Published: December 2024

Abstract

Introduction
The rising number of individuals identifying as transgender (TG) has increased the demand for accessible gender-affirming care. Although surgical programs providing gender-affirming surgery (GAS) have expanded nationally, genital hair removal remains a significant barrier to bottom surgery. This procedure is often performed at select facilities and typically not covered by insurance, with costs ranging from $1,000 to $3,000. Moreover, hair removal is time-consuming, requiring multiple sessions over several months and can be uncomfortable for patients. Therefore, there is a critical need for surgical advancements that facilitate timely GAS while addressing these challenges. To address this issue, we describe a novel surgical procedure using an ovine xenograft to replace scrotal skin, thereby eliminating the need for hair removal.

Objective
To introduce a novel surgical technique, the Tubularized Augmented Peritoneal Cap (TAPCap), which enables feminizing GAS without requiring hair removal procedures.

Methods
The TAPCap technique employs an ovine xenograft to replace the scrotal skin traditionally used to line the vaginal canal. This method combines the Davydov technique for robotic vaginoplasty with the addition of a tubularized graft. The procedure was offered to patients who cited hair removal as a significant barrier to surgery. A single surgeon performed all surgeries in this case series. Intraoperative and postoperative protocols followed standard robotic penile inversion vaginoplasty procedures. Six patients underwent the TAPCap procedure between August 2023 and November 2023. A 10 cm x 15 cm segment of the three-cell ovine graft was tubularized over the largest dilator using a 3-0 chromic suture. A 3-0 Stratafix suture was then used to secure the graft intracorporeally in a clockface pattern to the inner cut edge of the peritoneum. The external portions of the surgery followed the standard penile inversion vaginoplasty technique.

Results
Six patients were included in this case series. The time to create the tubularized graft ranged from 7 to 10 minutes. The average time for robotic dissection and TAPCap fixture was 53 minutes. The final canal depth for the patients ranged from 16 cm to 19 cm. Patients were followed for a minimum of 3 months, with the longest follow-up being 6 months. Two patients experienced superficial wound infection/dehiscence, and one patient had urinary retention requiring a catheter for an additional week within the first 30 days. One patient ceased dilating her canal at the six-week mark, resulting in moderate canal stenosis. The five patients with patent canals have cited high satisfaction on clinical follow up and all have orgasmic function.

Conclusions
The TAPCap vaginoplasty is a reproducible technique that eliminates the need for genital hair removal before GAS. This case series demonstrates reliable postoperative results. The procedure should be offered to patients who prefer not to undergo hair removal or cannot afford it.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Aroa Biosurgery.