Hysterectomy and Bilateral Adnexectomy by Laparoscopic Single Port Access for Female to Male Transsexualism

摘要

Total hysterectomy with bilateral salpingo-oophorectomy (THSO) is an important part of sex reassignment surgery (SRS) in the treatment of female to male (FtM) transsexualism [1]. It is important for these patients that the THSO be as minimally visible and cause as little damage as possible from an esthetic perspective. For these reasons, this intervention is generally performed by classic laparoscopy rather than laparotomy. Laparos-copy by a single-point access (SPA) technique uses only one parietal access site. This technique allows a variety of different gynecologic procedures including total hysterectomy [2]. Its advantages include a reduction in postoperative pain, a faster return to normal activity, and a better esthetic result [2,3]. We sought to assess the feasibility of THSO by SPA laparoscopy for SRS in FtM transsexuals. We conducted this prospective study in 10 consecutive FtM transsexuals. THSO was performed only in FtM transsexuals participating in a standardized sex reassignment procedure managed by a multidisciplinary team in our institution. A transumbilical incision (2.5 cm) was made to introduce and clamp the SILS system. Working instruments and a 5-mm lap-aroendoscope were inserted into the three ports of the SILS system. The technique used for THSO was similar to that used by standard laparoscopy [4]. The uterus and adnexae were removed through the vagina, and the vaginal cuff was closed by laparoscopy. Table 1 summarizes patients' characteristics and duration of the procedure and hospitalization; 8/10 patients (80%) were virgins and all were nulliparous. THSO was successfully performed with the SILS system in all patients, with no conversion to standard laparoscopy or laparotomy. No blood transfusion or postoperative complication was reported. All patients were seen at 1 month and no complications were reported.