Role of Total Laparoscopic Hysterectomy in the Reconstruction of the Genitalia in Transsexual Subjects

Overview

Objective:
Evaluation of the suitability of total laparoscopic hysterectomy as an adjunctive procedure in the female-to-male transsexual reassignment surgery. Surgical reassignment surgery in the transsexual is not a frequent procedure. The expertize of an gynaecologist in the treatment of the syndrom is neccessary as well as the input of other specialists such as psychiatrists, psychologists, plastic and reconstructive surgeons and urologists. The gynaecological surgeon usually performes the hysterectomy and in some cases also colpectomy.Subject: Case report.Methods: The authors analyse their own surgical experience with the above mentioned syndrom in the patient in whom the surgical reconstruction took place in two phases. In the first phase the Total Laparoscopic Hysterectomy with Bilateral Salpingo Ophorectomy (TLH, BSO) was performed. Of note is that this procedure was chosen due to extremely narrow vaginal canal with no uterine descent. For the second phase of the surgery the patient was referred to the urological surgeon.Results: The duration of the surgery was 54 minutes, the blood loss was not measurable. We have not encountered any per- and postoperative complications and the patient was discharged after 48 hours.Conclusion: We conclude that the TLH/BSO approach has enabled to us to preserve the vital structures needed for reconstruction of external genitalia, e.g. inferior epigastric vessels and rectus muscles were not disturbed. This approach is complex and has clear advantages in comparison to vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy or even total abdominal hysterectomy. It does garantee a smooth removal of both ovaries and it is not dependent on the size of the vagina or uterine descent.

Key words:
transsexuality, surgical reconstruction, two phases of reconstruction