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Objectives To demonstrate the feasibility, surgical technique and initial outcomes of robotic vaginoplasty with peritoneal flap (Davydov) technique for vaginal reconstruction. Methods Following appropriate preoperative patient counseling, 11 consecutive patients underwent robotic vaginoplasty with the da Vinci (Intuitive Surgical, Sunnyvale CA) multi-port Xi and single port (SP) robotic platforms. Perioperative and postoperative outcomes of interest were retrospectively collected. Results Between March 2019 and October 2019, a total of 11 patients have undergone robotic vaginoplasty with peritoneal flap technique at our institution – 9 using the da Vinci SP platform and 2 using the da Vinci Xi platform. Reasons for vaginoplasty included primary gender-affirming genital reconstruction, vaginal stenosis after gender confirmation surgery, and vaginal hypoplasia secondary to disorders of sexual development. Mean operative time was 267.2 +/- 85.9 minutes. Initial post-operative mean vaginal depth was 13.9 +/- 0.5 cm. Mean estimated blood loss was 131.8 +/- 92.9 ml. Mean length of stay was 5.2 +/- 0.6 days and time to return of bowel function was 1.7 +/- 0.9 days. Thirty-day readmission rate was 18% (N = 2/11) with 1 patient (9%) requiring surgical revision of the neovagina. Conclusions Robotic-assisted Davydov technique is a potentially applicable, efficacious and safe method of vaginal reconstruction in cis-gender and transgender individuals.

Objective To describe the design and build of a novel phantom for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy and present pilot testing results from a multicenter urology resident training session. Methods We cast our phantom from polyvinylchloride-plastisol that features 10 mm and 5 mm blue clay tumors, a urethral lumen, and an echogenic capsule. T2-weighted images were acquired with a 3T MR750 scanner (GE Healthcare, Boston, MA). Fusion testing was performed on the bkFusion system (BK ultrasound, Peabody, MA) with MIM Symphony software (MIM, Cleveland, OH) and an 18-gauge Bard Monopty disposable gun (Bard, Murray Hill, NJ). Twenty residents from 6 urology programs in Chicago performed proctored user testing. Results The per phantom material cost was $12. The phantom was compatible with all necessary equipment to create a MRI/US fusion data set. MRI and US imaging characteristics were excellent with hypointense lesions. Image fusion was achieved through both end and side fire ultrasound probes. The phantom allowed for biopsies to be performed, and target lesion hits were confirmed by visual inspection of core samples. 38% (8/21) of urology resident pilot testing participants had previously performed a fusion biopsy. The mean postsession survey scores were (1-10 [best]): realism 9.0, usefulness 9.4, ease of use 9.1, ease of orientation 8.9, and overall experience 9.3. Conclusion This simple and inexpensive phantom allows for training and accuracy testing of MRI/US fusion biopsy hardware and software platforms.