title: Laparoscopic Vaginal-Assisted Hysterectomy With Complete Vaginectomy for Female-To-Male Genital Reassignment Surgery.
abstract: OBJECTIVE
  Total hysterectomy with bilateral salpingo-oophorectomy and vaginectomy for genital reassignment surgery is a complex procedure that is usually performed with a combined vaginal and abdominal approach. The aim of this study was to describe the feasibility of laparoscopic vaginectomy in sex reassignment surgery.
  
  
  METHODS
  We reviewed the relevant medical history, intra/postoperative complications, and surgical results of all patients diagnosed with gender dysphoria and submitted to totally laparoscopic gender confirmation surgery in our department between January 2007 and March 2015. In total, 23 patients underwent total hysterectomy with bilateral salpingo-oophorectomy and vaginectomy in a single intervention. The vaginal mucosa was conserved to be used for the penile neourethra during the subsequent phalloplasty.
  
  
  RESULTS
  The surgeries had an average operating time of 155 ± 42 minutes. No intraoperative complications were registered. In all patients, the vagina was totally removed, and, in most cases (n = 20), we were able to remove laparoscopically more than 50% of the vagina. Three patients had postoperative complications. One patient presented with hemoperitoneum on the second postoperative day; another presented with prolonged urinary retention, and a third patient developed a perineal hematoma 1 month after surgery. Patients were discharged less than 72 hours after surgery, except the patient who developed a postoperative hemoperitoneum. For all patients, we obtained an adequate specimen of vaginal mucosa to reconstruct the penile neourethra for the subsequent phalloplasty.
  
  
  CONCLUSIONS
  This study suggests the feasibility of laparoscopic vaginectomy in genital reassignment surgery. The procedure can be executed as a continuation of the hysterectomy with the potential advantage of the laparoscopy providing better exposure of the anatomic structures with low blood losses (less than 500 mL) and few complications. Furthermore, using this approach, adequate-sized vaginal mucosa flaps were obtained for the urethral reconstruction.
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal. Electronic address: ana.ofgc@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Gomes da Costa
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal; Faculty of Medicine of Lisbon University, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Valentim-Lourenço
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Samuel
authors.initials: S
authors.lastname: Santos-Ribeiro
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: Carvalho Afonso
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Henriques
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Ana Luísa
authors.initials: AL
authors.lastname: Ribeirinho
authors.affiliation: Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal; Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Décio Ferreira
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000818:Animals; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005187:Fallopian Tubes / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007045:Hysterectomy, Vaginal / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008297:Male; D010052:Ovariectomy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D057830:Gender-Affirming Surgery / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Genital reassignment surgery; Laparoscopic; Vaginectomy