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

BACKGROUND: Gender-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 vagin...

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Autores principales: Groenman, Freek, Nikkels, Charlotte, Huirne, Judith, van Trotsenburg, Mick, Trum, Hans
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501901/
https://www.ncbi.nlm.nih.gov/pubmed/27844235
http://dx.doi.org/10.1007/s00464-016-5333-8
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author Groenman, Freek
Nikkels, Charlotte
Huirne, Judith
van Trotsenburg, Mick
Trum, Hans
author_facet Groenman, Freek
Nikkels, Charlotte
Huirne, Judith
van Trotsenburg, Mick
Trum, Hans
author_sort Groenman, Freek
collection PubMed
description BACKGROUND: Gender-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. METHODS: Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study. RESULTS: Median 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. CONCLUSION: To 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 MATERIAL: The 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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spelling pubmed-55019012017-07-24 Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study Groenman, Freek Nikkels, Charlotte Huirne, Judith van Trotsenburg, Mick Trum, Hans Surg Endosc Dynamic Manuscript BACKGROUND: Gender-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. METHODS: Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study. RESULTS: Median 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. CONCLUSION: To 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 MATERIAL: The online version of this article (doi:10.1007/s00464-016-5333-8) contains supplementary material, which is available to authorized users. Springer US 2016-11-14 2017 /pmc/articles/PMC5501901/ /pubmed/27844235 http://dx.doi.org/10.1007/s00464-016-5333-8 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Dynamic Manuscript
Groenman, Freek
Nikkels, Charlotte
Huirne, Judith
van Trotsenburg, Mick
Trum, Hans
Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title_full Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title_fullStr Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title_full_unstemmed Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title_short Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
title_sort robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study
topic Dynamic Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501901/
https://www.ncbi.nlm.nih.gov/pubmed/27844235
http://dx.doi.org/10.1007/s00464-016-5333-8
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