Laparoscopic Vaginal-Assisted Hysterectomy With Complete Vaginectomy for Female-To-Male Genital Reassignment Surgery

Costa, Ana Gomes da; Valentim-Lourenço, Alexandre; Santos‐Ribeiro, Samuel; Afonso, M. Carvalho; Henriques, Alexandra; Ribeirinho, Ana Luísa; Ferreira, João Décio

doi:10.1016/j.jmig.2015.12.014

Cited by 26 publications

(16 citation statements)

References 18 publications

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“…It is therefore important to stop testosterone administration two weeks prior to surgery, in order to avoid excessive intraoperative bleeding. Some authors prefer laparoscopic hysterectomy in transsexuals due to better visualization of tissues and control of hemorrhage [ 3 , 19 , 20 ]. Gomes da Costa et al reported 1 out of 23 transgender patients (4.3%) with significant postoperative bleeding, who underwent second-look laparoscopy and hemostasis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors prefer laparoscopic hysterectomy in transsexuals due to better visualization of tissues and control of hemorrhage [ 3 , 19 , 20 ]. Gomes da Costa et al reported 1 out of 23 transgender patients (4.3%) with significant postoperative bleeding, who underwent second-look laparoscopy and hemostasis [ 20 ]. O'Hanlan et al's study includes 41 transsexuals who underwent laparoscopic hysterectomy; one included a conversion to open laparotomy for observation of a large retroperitoneal hematoma (2.4%), while two (4.9%) required reoperation due to excessive bleeding [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Hysterectomy with Bilateral Salpingo-Oophorectomy in Female-to-Male Gender Affirmation Surgery: Comparison of Two Methods

Jeftović

Stojanovic

Bizic

et al. 2018

BioMed Research International

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Introduction The optimal route for hysterectomy with bilateral salpingo-oophorectomy in female-to-male gender affirmation surgery is still under debate, due to the quite limited and inconsistent published data. The aim of this study is to present and compare the results of vaginal and laparoscopic hysterectomy as part of gender affirmation surgery in female-to-male transsexuals. Materials and Methods Between 2012 and 2017, 124 female-to-male transsexuals, aged 18–43 years (mean age: 28.5), underwent hysterectomy with bilateral salpingo-oophorectomy, followed by colpocleisis and gender affirmation surgery. Transvaginal and laparoscopic hysterectomy were performed in 92 and 32 patients, respectively. Standard outcome measures (types and rates of complications, operative time, blood loss, and postoperative hospital stay) were used to compare the two groups of patients. Results The mean follow-up was 41 months (ranged from 6 to 65 months). The duration of transvaginal approach was significantly shorter (51 minutes compared to 76 minutes, p < 0.001). The total complication rates (less than 3%), reoperation rates (0%), blood loss, and postoperative hospital stays (4.3 days compared to 4.5 days) showed no statistical difference. Conclusions Both approaches are safe, with minimal complications. However, we prefer transvaginal hysterectomy due to its shorter operative time, cost-effectiveness, and simpler continuation with one-stage female-to-male gender affirmation surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hysterectomy with Bilateral Salpingo-Oophorectomy in Female-to-Male Gender Affirmation Surgery: Comparison of Two Methods

Jeftović

Stojanovic

Bizic

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…In this regard, the LPS surgery may represent the first choice to perform hysterectomy in patients undergoing affirmative gender surgery as compared to the vaginal route. In most patients the nulliparity, the scarce frequent penetrative sexual intercourse, the absent uterine prolapse, the required bilateral adnexectomy, and the vaginal atrophy related to the low levels of estradiol due to the testosterone therapy are considered factors determining the vaginal approach more challenging [10].…”

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confidence: 99%

“…The reduced tissue trauma by the extreme-precision movements may allow to perform concomitant colpectomy with reduced risk of complication that are in general challenging both by vaginal and classic LPS route. Additionally, it may allow to perform immediate reconstructive surgeries, such as metoidioplasty or short-term phalloplasty [10].…”

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confidence: 99%

Robotic Surgery in Female-To-Male Transition: A Possible Way for Further Improvement

Laganà

Garzon

Raffaelli

et al. 2019

Journal of Investigative Surgery

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“…Besides the advantage of combining two procedures, RaLC potentially has less complication risk and shorter hospital stay than the vaginal approach. Although there have been reports of laparoscopic colpectomy with low complication rate, they describe that in many cases, part of the vagina still needs to be removed vaginally [16]. We chose the robot over conventional laparoscopy because of a potential larger learning curve with conventional laparoscopic colpectomy, the need for vaginal removal of remnant vagina, 3D high-definition camera for fine surgery using the robot, low intra-abdominal pressure possibility using the robot and experience with robotic surgery in our center.…”

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confidence: 99%

Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study

et al. 2016

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BackgroundGender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis. Therefore, at our center, colpectomy has become a standard procedure prior to phalloplasty and metoidioplasty with urethral elongation. Colpectomy is known as a procedure with potentially serious complications, e.g., extensive bloodloss, vesicovaginal fistula or rectovaginal fistula. Colpectomy performed via the vaginal route can be a challenging procedure due to lack of exposure of the surgical field, as many patients are virginal. Therefore, we investigated whether robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH–BSO) followed by robot-assisted laparoscopic colpectomy (RaLC) is an alternative for the vaginal approach.MethodsRobot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study.ResultsMedian length of the procedure was 230 min (197–278), which reduced in the second half of the patients, median blood loss was 75 mL (30–200), and median discharge was 3 days (2–3) postoperatively. One patient with a major complication (postoperative bleeding with readmission and transfusion) was reported.ConclusionTo our knowledge, this is the first report of RaLC. Our results show that RaLC combined with robot TLH–BSO is feasible as a single-step surgical procedure in FtM transgender surgery. Future studies are needed to compare this technique to the two-step surgical approach and on its outcome and complication rates of subsequent phalloplasty.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-5333-8) contains supplementary material, which is available to authorized users.

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Laparoscopic Vaginal-Assisted Hysterectomy With Complete Vaginectomy for Female-To-Male Genital Reassignment Surgery

Cited by 26 publications

References 18 publications

Hysterectomy with Bilateral Salpingo-Oophorectomy in Female-to-Male Gender Affirmation Surgery: Comparison of Two Methods

Hysterectomy with Bilateral Salpingo-Oophorectomy in Female-to-Male Gender Affirmation Surgery: Comparison of Two Methods

Robotic Surgery in Female-To-Male Transition: A Possible Way for Further Improvement

Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study

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