Robotic-assisted laparoscopic colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy versus a vaginal colpectomy in trans masculine individuals

• Published in: International journal of transgender health Vol. 25; no. 4; p. 878
• Main Authors: Nikkels, Charlotte, Vestering, Asra, Huirne, Judith A F, de Leeuw, Robert A, van Mello, Norah M, Groenman, Freek A
• Format: Journal Article
• Language: English
• Published: United States 01.10.2024
• Subjects: vaginectomy; Clavien-dindo classification; urethral lengthening; colpectomy; robotic-assisted surgery; gender-affirming surgery; transgender
• ISSN: 2689-5277
• DOI: 10.1080/26895269.2023.2278737

Colpectomy entails the surgical removal of the vaginal epithelium. It may be performed in trans-masculine individuals as gender-affirming surgery. Vaginal colpectomy is a complex procedure with potentially severe complications. As alternative, robotic-assisted laparoscopic colpectomy combined with robotic-assisted laparoscopic hysterectomy and possible bilateral salpingo-oophorectomy (RAC+) can be performed. To compare surgical outcomes of robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy with a vaginal colpectomy after previous hysterectomy in trans masculine patients. A single-center retrospective cohort study included 310 transgender men who underwent either robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy (RAC+) (  = 140) or vaginal colpectomy (  = 170) between January 2006 and December 2019. Surgical details and clinical outcomes were collected from all patients. The median intra-operative blood loss was 100 mL (50-200) in RAC + and 300 mL (200-450) in vaginal colpectomy (  < 0.01). The median duration of hospital stay was 2 days (1-2) in the RAC + group and 3 days (2-4) in the vaginal group (  < 0.01). In the RAC + group 63 (45%) peri-operative complications were reported, compared to 93 (54.7%) in the vaginal group [OR 0.7 (0.4-1.1)]. The main difference was found in intra-operative complications (RAC+ 0.7% vaginal 10.6%). Furthermore, the total number of complications graded 3a and higher was significantly lower in the RAC + group [OR 0.3 (0.2-0.7)]. Although RAC + entailed a more extensive procedure, compared to vaginal colpectomy, RAC + had a lower risk of severe peri-operative complications, requiring re-intervention; intra-operative blood loss was lower and hospital stay shorter. Both routes of colpectomy are complex procedures with potentially severe complications. Future studies are needed to study whether robot-colpectomy could be a safe alternative to vaginal colpectomy in patients with a previous hysterectomy.