Robotic Hysterectomy as a Step of Gender Affirmative Surgery in Female-to-Male Patients

To evaluate the feasibility and safety of robotic hysterectomy in the "transgender male/non-conforming" population and the short and long-term surgical outcomes of robotic surgery in these patients.

A retrospective analysis was carried out from February 2016 to January 2018. Twenty female transgender patients with a previous psychiatric diagnosis of gender dysphoria who did not present genital pathologies were included in the study. The robotic hysterectomies were performed from June 2016 to March 2018 using a Da Vinci Xi Robot (Intuitive Surgical, Sunnyvale, CA, USA).

No intraoperative or postoperative complications were recorded. The median duration of the intervention was of 90 minutes, including docking which lasted 16 minutes, while the median stay in the operating room was of 140 minutes. The median time of duration of intervention was of 90 minutes. The median blood loss was about 90 ml with a percentage decrease in hemoglobin between pre- and post-operative of about 8%. Postoperative pain was assessed using the VAS scale in the immediate postoperative period, on the first and second day, resulting of 3 and 2, respectively. The pathological examination of surgical specimens confirmed the absence of malignancy.

The robotic approach represents a feasible, safe, and effective surgical option for hysterectomy for "transgender male" affected by gender dysphoria.