Two stitches were passed between the distal end of the cutaneous pouch and the bottom of the perineal cavity. The passage of the needles could be observed by the microendoscope. At the end of the procedure, the microendoscope was removed and the pneumoperitoneum was completely deflated via the Veress needle. The urethra was severed and a urethrostomy performed through a slit in the skin lining the neovagina, below the symphysis pubis. The operation ended with the formation of labia obtained with the scrotal skin and the construction of a pseudoclitoris.
Surgical techniques are well codified and relatively simple to perform.
Microsurgery is useful for performing the most delicate procedures such as neurovascular bundle dissection, glans conversion into clitoris and urethral dissection and reanastomosis. Postoperative complications are generally not severe and include the possible stenosis of the new urethral meatus, the necrosis of the glans and urethral fistulas. These may be avoided with experience and the use of atraumatic techniques during the operation. Stenosis of the neovagina is generally due to improper postoperative dilation by the patient. Rectal injury during the perineal dissection is a severe intraoperative complication.