Gender affirmation surgery encompasses a range of procedures aimed at aligning an individual’s physical characteristics with their gender identity. Genital gender affirmation surgery may benefit from robotic assistance as the platform offers improved visualization and precise dissection, especially in the deep pelvis [1]. The most common applications for robotic surgery include peritoneal vaginoplasty and vaginectomy (vaginal closure), performed for feminizing and masculinizing indications, respectively. Currently, the most widely available robotic platform is the da Vinci Xi (multi-port) or SP (single-port) system (Intuitive Surgical Inc., Sunnyvale, CA). These systems will be discussed in this chapter.