Abstract
Background: Colpectomy entails the surgical removal of the vaginal epithelium. It may be performed in trans-masculine individuals as gender-affirming surgery. Vaginal colpectomy is a complex procedure with potentially severe complications. As alternative, robotic-assisted laparoscopic colpectomy combined with robotic-assisted laparoscopic hysterectomy and possible bilateral salpingo-oophorectomy (RAC+) can be performed. Aim: To compare surgical outcomes of robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy with a vaginal colpectomy after previous hysterectomy in trans masculine patients. Methods: A single-center retrospective cohort study included 310 transgender men who underwent either robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy (RAC+) (n = 140) or vaginal colpectomy (n = 170) between January 2006 and December 2019. Surgical details and clinical outcomes were collected from all patients. Results: The median intra-operative blood loss was 100 mL (50-200) in RAC + and 300 mL (200-450) in vaginal colpectomy (p < 0.01). The median duration of hospital stay was 2 days (1-2) in the RAC + group and 3 days (2-4) in the vaginal group (p < 0.01). In the RAC + group 63 (45%) peri-operative complications were reported, compared to 93 (54.7%) in the vaginal group [OR 0.7 (0.4-1.1)]. The main difference was found in intra-operative complications (RAC+ 0.7% vs. vaginal 10.6%). Furthermore, the total number of complications graded 3a and higher was significantly lower in the RAC + group [OR 0.3 (0.2-0.7)]. Conclusion: Although RAC + entailed a more extensive procedure, compared to vaginal colpectomy, RAC + had a lower risk of severe peri-operative complications, requiring re-intervention; intra-operative blood loss was lower and hospital stay shorter. Both routes of colpectomy are complex procedures with potentially severe complications. Future studies are needed to study whether robot-colpectomy could be a safe alternative to vaginal colpectomy in patients with a previous hysterectomy.