Laparoscopic Colon Vaginoplasty
Transgender surgery aligns the body with one’s gender identity. WIH Hospital has over 20 years of expertise in this specialized field.
Laparoscopic Colon Vaginoplasty
Colon vaginoplasty, commonly referred to as sigmoid colon vaginoplasty, is a gender-affirming procedure that uses a segment of the sigmoid colon to create a functional and self-lubricating neovagina. This surgical method is particularly effective for individuals seeking greater vaginal depth, natural lubrication, and long-term durability. The use of colon tissue offers unique benefits due to its inherent properties, making it an excellent alternative when insufficient local genital tissue is available.
At WIH International Hospital, we specialize in Laparoscopic Colon Vaginoplasty, an advanced gender-affirming procedure that creates a functional and durable neovagina using a segment of the sigmoid colon. Unlike traditional methods relying on local genital tissue, this approach utilizes the patient’s colon tissue, offering superior natural lubrication, elasticity, and longevity. This minimally invasive technique sets a new standard in patient safety, recovery, and outcomes.
Laparoscopic Colon Vaginoplasty vs. Traditional Colon Vaginoplasty
While both techniques use a segment of the sigmoid colon to construct the neovagina, laparoscopic colon vaginoplasty offers significant advantages:
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Minimally Invasive Surgery
Laparoscopic colon vaginoplasty uses small incisions and specialized instruments, reducing trauma to surrounding tissues. In contrast, traditional colon vaginoplasty involves larger incisions, which can lead to prolonged recovery times and a higher risk of complications.
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Reduced Recovery Time
The minimally invasive nature of the laparoscopic approach typically results in shorter hospital stays, less postoperative discomfort, and a faster return to daily activities compared to traditional open surgery.
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Enhanced Precision
Laparoscopic techniques allow surgeons to operate with high precision, minimizing the risk of complications and optimizing the placement and function of the neovagina.
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Smaller Scars
Tiny incisions result in minimal scarring, which not only improves the aesthetic outcome but also reduces the risk of wound-related complications.
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Improved Outcomes
The laparoscopic approach offers better control over blood vessels and tissues, contributing to a more secure attachment of the colon segment and reduced risk of complications such as blood loss or infection.
Step 1: Creating the Vaginal Opening and Canal
The vaginal opening is placed about 2–3 cm above the anus. Dissection is carefully performed along the anterior wall of the rectum, creating a tunnel between the rectum and urinary system—starting from the urethra, through the prostate, to the bladder. The vaginal canal is created to a depth of at least 6 inches, even in patients with small genitalia or prior circumcision.
Step 2: Bilateral Orchiectomy
The testicles and spermatic cords (including the vas deferens) are removed as close to the inguinal ring as possible to ensure a smooth contour without any palpable remnants in the groin.
Step 3: Creating the Clitoris, Clitoral Hood, and Frenulum
The clitoris is sculpted to a proportionate feminine size and accurately positioned along the vulva axis. The clitoral hood and frenulum are carefully constructed to enhance both aesthetics and sensitivity. Sensory nerve branches from the pudendal nerve are preserved and well-innervate not only the clitoris but also the hood, frenulum, and the sensitive area just below the clitoris. This nerve-preserving approach—unique to the NPI technique—supports orgasmic potential and long-term sexual function.
Step 4: Penectomy and Urethral Shortening
The penis is removed, while preserving the penile skin for later use in reconstructing external genital structures. The urethral opening is repositioned just above the vaginal opening, mirroring cis-female anatomy. Surrounding corpus spongiosum (spongy tissue) is meticulously removed to prevent residual tissue lumps that may become engorged during sexual arousal. This ensures a smooth, natural-looking urethral meatus.
Step 5: Constructing the Labia Minora and Vaginal Introitus
Dr. Chettasak uses the inner prepuce and upper penile skin to form the labia minora, shaping a delicate pink inner lining. The lower penile skin is vertically aligned to form the introitus and posterior fourchette with a realistic V-shaped opening.
Step 6: Creating the Outer Labia (Labia Majora Reconstruction)
The scrotal skin is carefully divided into two portions.
The first portion is sculpted to form the labia majora (outer labia). Dr. Chettasak meticulously designs this area to achieve a natural, full contour that resembles the appearance of natal female anatomy. This artistic shaping enhances the overall external aesthetics of the vulva.
Step 7: Bowel Segment Preparation and Vaginal Lining Insertion (Sigmoid Colon Vaginoplasty)
In sigmoid colon vaginoplasty, a 12–15 cm segment of the sigmoid colon is selected and mobilized by the colorectal surgery team. The segment is carefully detached while preserving its vascular pedicle to ensure continuous blood supply.
The harvested colon segment is thoroughly cleansed, sealed at one end, and shaped into a self-lubricating neovaginal lining. Its natural mucosal surface closely resembles that of a natal vaginal canal, supporting both function and comfort.
The bowel segment is then inserted into the previously dissected vaginal cavity and sutured to the edges of the vaginal opening (introitus) with precision.
To maintain shape and promote initial tissue integration, sterile gauze packing is gently placed inside the neovaginal canal for 5 days before being removed.
Ideal Candidates for Laparoscopic Colon Vaginoplasty
Laparoscopic Colon Vaginoplasty is suitable for patients who:
- Desire a self-lubricating neovagina that remains moist and comfortable over time
- Need greater vaginal depth than can be achieved with penile or skin graft tissue alone
- Have undergone previous surgeries that limit available local tissue
- Prefer a long-lasting, functional solution with reduced risk of stenosis (narrowing of the canal)
Laparoscopic Colon Vaginoplasty Procedure
Our surgeons utilize minimally invasive laparoscopic techniques to perform the procedure with precision and reduce recovery time. The key steps include:
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Laparoscopic Access and Colon Segment Harvesting
Using small incisions, our surgical team accesses the abdomen laparoscopically. A carefully selected portion of the sigmoid colon is removed and prepared to serve as the vaginal lining. The colon segment is chosen for its natural lubrication, which enhances the functionality of the neovagina.
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Vaginal Canal Creation and Colon Segment Placement
The surgical team creates a tunnel in the pelvic area for the neovagina. The harvested colon segment is then precisely positioned and attached to create the vaginal canal, ensuring secure attachment and proper blood supply.
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Final Adjustments and Aesthetic Refinement
The external appearance of the genital area is adjusted for a natural and aesthetically pleasing result. Our team takes great care to ensure the anatomical integrity and functionality of the neovagina.
Recovery and Aftercare
Postoperative care is crucial for successful outcomes:
- Hospital Stay: Patients typically stay in the hospital for monitoring and initial recovery.
- Vaginal Dilation: A structured dilation routine is essential to maintain vaginal depth and prevent narrowing. Our team provides personalized guidance on proper dilation techniques.
- Hygiene and Self-Care: Patients receive detailed instructions on maintaining hygiene to prevent infection and promote healing.
- Activity Guidelines: Gradual resumption of daily activities is recommended, with specific guidelines to avoid strenuous activities during the initial recovery period.
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