Comparison of hysterectomy techniques in a group of patient operated for the diagnosis female to male transsexualism

Summary

Objective:
Comparison of duration of surgery, blood loss, complications, lenght of post-operative hospitalisation and post-operative morbidity in a group of patient operated for the diagnosis FtM transsexualism.

Design:
Retrospective clinical study.

Material:
In our set of patients were 163 FtM transsexuals with caryotype 46 XX and normal gynecological finding (81 virgins). They were operated on from 1998–2012 at Department of Obstetrics and Gynecology The First Faculty of Medicine Charles University in Prague and Hospital Na Bulovce after at least of 12 months of hormonal preparation.

Methods:
We used following types of hysterectomy and bilateral adnexectomy: total abdominal hysterectomy from infraumbilical median laparotomy (AHL) or from suprapubic transverse incision – Pfannenstiel (AH), laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH). In two patients TLH and colpectomy was performed in one setting.

Results:
In the 23 AHL group the duration of the surgery was 54 minute, blood loss was 226 ml and the length of post-operative hospitalisation was 6.7 days. In the 22 individualy of AH group the duration of the surgery was 60 minute, blood loss was 240 ml and the length of post-operative hospitalisation was 6.1 days. In 4 patients of LAVH group the duration of the surgery was 73 minute, blood loss 200 ml and the length of post-operative hospitalisation was 5 days. In the TLH group (112 pts) the duration of the surgery was 91 minutes, blood loss was 121 ml and the length of post-operative hospitalisation was 4.4 days. In the 2 TLH with colpectomy group the duration of the surgery was 152 minute, blood loss was 250 ml and the length of post-operative hospitalisation was 5.5 days.

In one case a peroperative lesion of urinary bladder occured and once a conversion TLH to AH for a strong vaginal bleeding was necessary.

Among postoperative complication in one case subileus in AH group was diagnosed, once vaginal bleeding, once haematoma in the suture and one case of secondary healing.

Postoperative complication after TLH included 4 times bleeding from vaginal suture, once haematoma in Douglas pouch, once seroma in the place of trocar insertion, once subileus. Once ureter was injured and treated by the ureteral stent insertion.

Complication after AHL and LAVH were not recognised.

Conclusion:
Total laparoscopic hysterectomy is the method of choice in the group of FtM transsexuals. This technique could be used also in nuliparous women with long and narrow vagina. Compared with laparotomic approach lower blood loss and shorter hospital stay was proved. Earlier restitution of full activity is another advantage. Musculus rectus abdominis flap can be used for phallus construction. The only significant disadvantage is a longer duration of surgery.

Keywords:
female to male transsexualism – total laparoscopic hysterectomy – duration of the surgery – blood loss – complication