Bibliographic record
Abstract
Introduction: Robotic-assisted peritoneal flap vaginoplasty (PFV) for feminizing gender-affirmation surgery is an alternative to penile inversion vaginoplasty (PIV) for transgender females (TF).There is little data on comparative outcomes complicating preoperative discussions to help direct patient choice.We compared perioperative and postoperative outcomes in patients undergoing PFV and PIV at a single institution.Methods: Forty-one TF who underwent primary PIV were compared to 41 TF who underwent PFV at a single center.Retrospective data was collected to assess preoperative penile skin length to the coronal sulcus, vaginal depth 1 month and 6 months postoperatively, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), perioperative complications, 30-day emergency department visits, and late complications requiring surgical revision.Variables were directly compared for PFV and PIV using parametric t-tests. Results:The PFV and PIV groups were similar in age, BMI, and presence of circumcision (61% vs. 58%, respectively).The PFV group had shorter penile length to coronal sulcus (7.0 cm [1.0-11] vs. 9.0 cm [6.0-13]), less EBL (250 cc [150-500] vs. 300 cc [150-700]), and similar LOS (3 days [1-18] vs 3 days [2-6]) and OT (339 min [269-447] vs. 365 min [249-524]) compared to the PIV group.Intraoperatively, there were 3 rectal injuries (RI) during PIV and none during PFV.Among the three patients with RI, 1 underwent diverting ileostomy.PFV patients had a lower risk of transfusions than PIV (2.44% vs. 9.75%).PFV and PIV experienced similar 30-day ED visits (17.1 vs. 17.1%),hospital readmissions (7.32 vs. 7.32%), and late complications requiring surgical revision (12.2 vs. 14.6%).The PFV group had deeper vaginal depth after 1 month (18 cm [13-20] vs. 15 cm [4.0-23]) and 6 months (18 cm [7.6-20] vs. 15 cm [2.5-19]).The ratio of vaginal depth after 1 month compared to penile length was greater in the PFV group (2.5 [0-18] vs. 1.7 [0.46-2.5]).Conclusions: In this cohort, PFV led to improved vaginal depth as compared to PIV, despite shorter preoperative penile skin length.These findings suggest PFV is advantageous in TF with shorter penile length desiring greater vaginal depth.Bowel complications were lower among TF who underwent PFV vs. PIV.PFV may confer an advantage in operative time and blood loss compared to PIV, with a reduced need for transfusion in the postoperative setting.Further studies are needed to determine long-term outcomes of vaginal depth, the comparable safety profile in this study supports the use of primary PFV as an alternative to PIV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.465 | 0.145 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".