I'm going for vaginoplasty at NYU Langone in September. I'm doing their robotic-assisted peritoneal vaginoplasty, which they refer to in published research as Robotic-Assisted Peritoneal Flap Gender Affirming Vaginoplasty (RPGAV) . On Reddit and elsewhere on the internet, people refer to this as Peritoneal Pull-Through Vaginoplasty (or simply, PPT).

aside: I work in an office where I come into contact with a lot of Microsoft Powerpoint files, and every time I see the ".ppt" file extension I think of peritoneal pull-through... so yeah, I'd be happy to get a new acronym for that, lol. I digress...

At NYU Langone, Dr. Bluebond-Langner is the plastic surgeon, and Dr. Zhao is the urological surgeon. I think this may be a bit of a reductive description, but it seems like Dr. Zhao is in charge of most of the "inside" work, and Dr. Bluebond-Langner is in charge of the "outside" work. And from the results I've been able to find online, they're like,,,,, really good at this :o

I'd commented on a previous thread about this method, but I was wrong about a few important things. I'm trying to collect all of this information in one place. Hopefully it's useful for others who are interested! I've included selections from my past comment in italicized block quotes. The other text is my updated commentary/notes.

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A lot of people talk about peritoneal tissue being great because it produces lubrication. But when I asked the surgical team about this (Dr. Bluebond-Langner and Dr. Zhao) they emphasized that this should NOT be expected.

I’ve also read other people who had PPT say that they lubricate too much, to the point that they don’t consider it “lubrication”, but rather discharge (I believe this was an account by a patient of Dr. Jess Ting, but I cannot remember when/where I saw this). I think this may be more common in full PPT: where the entire canal is made from peritoneal tissue. More peritoneal tissue = more secretion.

This is the thread where I read about issues with PPT. A number of people were saying it's not a good method, that Ting had stopped doing it, etc. But it's very much second- and third-hand commentary. I would take the published science a lot more seriously than anecdotal information.

And in regards to the "lubrication" question -- when I asked Dr. Bluebond-Langner about this she was very quick to dismiss it as way, way over-hyped.

My takeaway: You should go into surgery expecting zero self-lubrication. If you do end up with a bit, great! But you should not anticipate it.

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From reading a paper that NYU Langone’s team published about the technique, it sounds like the PRIMARY benefit is that peritoneal tissue is different from skin graft tissue and adheres better to the back of where the canal is placed. This means that it has a lower rate of fistula occurring (which is a rare, but relatively more common occurrence with non-peritoneal tissue).

So, turns out it wasn't a paper, it was an abstract (a.k.a. the summary of information that would be included in the full paper). And, I also misrepresented their own description of the benefits of the procedure.

Here's a link to that abstract. -- from September 2018, involving a cohort of 20 trans women.

They actually don't mention the enhanced adherence. I believe this is something that was mentioned in the consultation, but I confused my info sources -- from my understanding, the peritoneal tissue acts as a better "anchor" for the back of the canal than the typical penile inversion graft does.

The primary benefits that they emphasize in the abstract are

1. the increased depth (~5cm additional depth)
2. the peritoneal tissue is well-vascularized (i.e. it has better access to blood flow), especially in comparison to what they refer to as "extra-genital" skin graft. What that means is, if there isn't enough genital tissue to work with, then they can use peritoneal tissue rather than pulling a skin graft from somewhere else on your body that isn't your genitals. Those sources of extra-genital skin grafts aren't as well-vascularized, which means that they are more likely to suffer "donor-site morbidity." I think this means tissue necrosis, but I'm not sure exactly... it doesn't sound good though :/

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Actually, I don’t know how many times they’ve performed the surgery, but when I spoke to them at the end of June they said they’d had 0 cases of fistula with this technique.

So, again, I might be misremembering the conversation, or I misinterpreted what was said. Here's another abstract from the NYU team 30469-3/fulltext) that was published in July 2020 that contradicts what I originally said.

This time they analyzed results from 145 trans women who underwent this type of surgery. In that group of 145,

• " Complications included transfusion (6%), rectovaginal fistula (1%) , bowel obstruction (2%), pelvic abscess (1%), and vaginal stenosis (7%). "

So, they have had fistula (among other complications) with this method, but it's a very small percentage. Vaginal stenosis is the highest complication (at 7%). Stenosis is when the canal shrinks or contracts, and it's usually caused when people don't follow the dilation schedule (although it can be caused by other things, too).

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The NYU method involves a portion of peritoneal tissue being used to “cap” the end of the canal (in a sort of cone shape). That “cap” is attached to the rest of the skin graft. So, the canal is composed of penile inversion (shaft skin) for the first third, scrotal tissue for the second third, and peritoneal tissue for the back third.

This is pretty much accurate, although they never use the word "cone" to describe the shape. The word that they use to describe it is the "apex" of the canal, but they don't ever specify the shape. I don't think that part matters too much though.

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I will be consulting with Dr. Bluebond-Langner again in September before my surgery. If anyone has questions, please feel free to post them below or DM me.