Tubularized Augmented Peritoneal Cap (TAPCap) Vaginoplasty

Nicholas Sellke; Shubham Gupta; Kirtishri Mishra

Gender affirming surgery, robotic surgery, vaginoplasty

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 typically not covered by insurance, with high out of pocket costs. Moreover, hair removal is time-consuming, requiring multiple sessions over several months and can be uncomfortable for patients.1 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. The Tubularized Augmented Peritoneal Cap (TAPCap) enables feminizing GAS without requiring hair removal procedures. 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 vaginoplasty2 with the addition of a tubularized graft. A single surgeon performed all surgeries in this case series. Intraoperative and postoperative protocols followed standard robotic penile inversion vaginoplasty procedures. A 10cm x 15cm 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. As displayed in this video, the TAPCap vaginoplasty is a reproducible technique that eliminates the need for genital hair removal before GAS. The case series in the video describes reliable postoperative results. The procedure can be offered to patients who prefer not to undergo hair removal or cannot afford it.

KM is a consultant for Aroa Biosurgery

1. Marks DH, Hagigeorges D, Manatis-Lornell AJ, Dommasch E, Senna MM. Excess hair, hair removal methods, and barriers to care in gender minority patients: A survey study. J Cosmet Dermatol. 2020;19(6):1494-1498. doi:10.1111/jocd.13164 

 2. Jacoby A, Maliha S, Granieri MA, et al. Robotic Davydov Peritoneal Flap Vaginoplasty for Augmentation of Vaginal Depth in Feminizing Vaginoplasty. J Urol. Published online June 2019. doi:10.1097/JU.0000000000000107