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Surgical Endoscopy

, Volume 31, Issue 8, pp 3363–3369

First Online: 14 November 2016Received: 17 May 2016Accepted: 31 October 2016

Abstract

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.

KeywordsRobot Laparoscopy Hysterectomy Colpectomy Transgender 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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Autor: Freek Groenman - Charlotte Nikkels - Judith Huirne - Mick van Trotsenburg - Hans Trum

Fuente: https://link.springer.com/article/10.1007/s00464-016-5333-8



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