A clinico – pathological study of hysterectomy with bilateral salpingo – oophorectomy operations performed for gender reassignment in transgender individuals. a retrospective descriptive study

Transgendered individuals can suffer a significant amount of psychological distress that can be alleviated through hormonal treatments and/or gender-affirming surgery. The World Professional Association for Transgender Health considers a hys terectomy and bilateral salpingo-oophorectomy medically necessary gender-affirming procedures for the interested transgendered male. This thesis presents a retrospective descriptive analysis about female – to male (FtM) gender – affirmation nongenital sur gical procedures involving the gynecological team at the HÜTF in Ankara. The aim of the study is to investigate patient characteristics, surgical times, per/postoperative complications and histopathological examination of the surgical specimen following Total Laparoscopic Hysterectomy (TLH) surgery in this population in order to confirm the feasibility of this technique. The study was approved by our institutional review board. The patient files of 34 consecutive cases of laparoscopic hysterectomy between January 2020 and August 2022 were reviewed and analyzed. We performed a retros pective chart review on 34 patients who underwent a 3-port TLH with BSO. Descrip tive statistics were generated related to sample characteristics and other variables of interest. Comparisons between the variables used t tests, X2 , Mann-Whitney U test, and Fisher's exact test, as appropriate for the level of data. Significance was preset at <.05. The median age, body mass index, and parity were 26.5, 23.6, and 0 respectively. The mean operative time, length of hospitalisation and specimen weight 179.3 mi nutes, 2.4 d, and 68.1 g, respectively. TLH procedures completed laparoscopically without conversion to open lapa rotomy. In 2 cases, due to very narrow vagina we couldn't place an uterine manipulator and for this reason, an open laparotomy was decided before laparoscopy started. There were 3 intraoperative complications (2 cases of vaginal mucosal tearing upon place ment of uterine manipulator, one case of pneumothorax). Vaginal mucosal tearing required suture ligation to achieve hemostasis. The patient experienced intraoperative pneumothorax was treated by placing a chest tube. There were no major postoperative complications. All patients were discharged uneventfully. There were no incidences of occult pathology; most patients demonstrated a weakly proliferative endometrium, atrophic or nonspecific alterations in cervix and cystic ovaries. From this study we can extrapolate that a 3-port approach to a total laparosco pic hysterectomy is a feasible, safe and efficient option when considering route of sur gery for transgender males with gender dysphoria. Owing to the limitations of the research such as its retrospective design and the relatively small sample size, randomized controlled studies should be performed on a larger population to confirm the results. Keywords: Transgender, gender reassignment, gender confirmation surgery, hysterectomy, female-to-male hysterectomy, 3-port laparoscopy.