Advances in Gender-Affirming Surgery
- incisionary
- Dec 28, 2025
- 2 min read
Updated: Dec 29, 2025
Gender-affirming surgery has changed significantly over the past decade. What was once
a small, highly specialized field has grown into a multidisciplinary area of medicine focused on precision, patient choice, and long-term outcomes. Recent advances are not about reinventing these procedures from scratch, but about refining how they are done and making them safer, more personalized, and more accessible.
One of the biggest shifts has been the introduction of robotic-assisted techniques,
especially in feminizing genital surgery. Robotic systems such as the da Vinci SP are now being used in certain types of vaginoplasty, including peritoneal vaginoplasty. In this approach, surgeons use tissue from the abdominal lining to help create the vaginal canal. According to Hopkins Medicine and recent NIH publications, robotics allow for smaller incisions, better visualization, and more precise movements in tight anatomical spaces. This can result in greater depth, improved lubrication, and potentially fewer complications compared to more traditional approaches.
Robotic platforms are especially useful in revision surgeries and complex cases, where
millimeter-level precision matters. Surgeons are able to operate with magnified,
three-dimensional views, which helps protect surrounding nerves and blood vessels. While
robotic surgery is not used for every patient or every procedure, it has become an important
option in modern gender-affirming care.
On the masculinizing side, phalloplasty has seen major improvements thanks to advances
in microvascular surgery. Using free-flap techniques such as the radial forearm or latissimus
dorsi flap, surgeons can now perform more complex reconstructions with better blood supply, improved sensation, and more natural appearance. Mount Sinai and ScienceDirect both highlight how refined microvascular methods have made single-stage or streamlined multi-stage phalloplasty more reliable than in the past. These techniques require extreme surgical skill, as surgeons must connect tiny blood vessels and nerves under a microscope to ensure the tissue survives and functions.
Beyond genital surgery, surgeons are paying more attention to body contouring and
fertility preservation. Procedures like fat grafting, liposuction, and body sculpting help align a person’s overall appearance with their gender identity. At the same time, fertility counseling and options such as egg or embryo freezing are being discussed earlier in care, especially before hormone therapy or surgery, allowing patients to preserve future family-building options.
Written by Vaishnavi Kulkarni at Incisionary
References
National Institutes of Health. (2025). The role of the surgical robot in gender-affirming surgery.
Mount Sinai Health System. (2024). Advancing the field of gender-affirming surgery.
ScienceDirect. (2021). A review of gender affirmation surgery: What we know, and what we
don’t.
Hopkins Medicine. (2024). Robotic-assisted vaginoplasty and peritoneal flap techniques.
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