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Intraoperative complications during gender-affirming laparoscopic hysterectomy in transgender men receiving
Samaneh Rokhgireh1, Sara Norouzi2, Roya Derakhshan3
1Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. s.rokhgireh@gmail.com.
Background:
Laparoscopic hysterectomy is a core component of gender-affirming care for transgender men. However, long-term testosterone therapy can lead to anatomical and tissue changes that increase the complexity of pelvic surgery.
Objective:
To describe the intraoperative complications encountered during gender-affirming laparoscopic hysterectomy in transgender men receiving testosterone therapy and discuss strategies for mitigation.
Methods:
This retrospective case series includes four transgender men undergoing total laparoscopic hysterectomy at a tertiary academic center. All patients were nulliparous virgins with ≥ 2.5 years of testosterone therapy. Clinical data, intraoperative events, and management strategies were analyzed.
Results:
Intraoperative complications included posterior cul-de-sac perforation (n = 1), cervical avulsion requiring conversion to laparotomy (n = 1), bladder dome injury (n = 1), and deep vaginal lacerations (n = 4). Contributing factors were cervical atrophy, stenosis, and limited vaginal elasticity due to long-term testosterone exposure. Multidisciplinary support was required in two cases (urology and vascular surgery). All patients recovered without long-term sequelae, although one expressed dissatisfaction with abdominal scarring.
Conclusion:
Gender-affirming hysterectomy in transgender men presents unique challenges related to testosterone-induced anatomic changes. Preoperative planning, gentle tissue handling, customized instrumentation, and patient counseling are critical to reduce risk and optimize outcomes.
