Our case is of a 49 yo male who underwent transformation to female using penile and scrotal skin inversion at an OSH. Unfortunately, during that procedure she developed a rectal injury which was repaired primarily. This however failed to heal and lead to a rectal-neovaginal fistula for which she underwent diversion using an end sigmoid colostomy. Subsequently, an attempt to repair the fistula using a rectal advancement flap failed. The patient was then referred to another OSH where an abdominal repair attempt was aborted due to difficulties. We performed redo repair of the recto-neovaginal fistula using a combined abdominal and perineal robotic technique utilizing intestinal vaginoplasty. We started with a robotic anterior pelvic dissection between the rectum and the neovagina. We then met our perineal dissection plane and removed the obliterated neovagina. The rectal fistula opening was repaired. The rectosigmoid portion of her Hartmann stump was isolated and used for the intestinal vaginoplasty, finally the end colostomy was taken down and a colorectal anastomosis was performed. All of the patient's complex surgical issues were repaired using a single operation.