Mohr-Sasson Aya, Hui Mason, Bonilla Miguel, Montealegre Alvaro
Division of Minimally Invasive Gynecological Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, Texas, USA.
Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel.
Int J Gynaecol Obstet. 2025 Jul 13. doi: 10.1002/ijgo.70342.
To describe outcomes of using a vaginal assisted natural orifice transluminal endoscopic surgery (vNOTES) approach to perform hysterectomy among transgender men as part of their gender-affirming care.
This is a retrospective observational cohort study conducted at a single university-affiliated tertiary medical center, including all patients undergoing hysterectomy by vNOTES approach between February 2022 and April 2023. Patients who underwent the surgery for gender-affirming care (exposure group) were compared with those who underwent surgery for all other indications (comparison group). vNOTES was used to perform hysterectomy with bilateral salpingectomy as recommended by the Society of Gynecologic Oncology. Patients' demographic, medical, and obstetrical and gynecological histories, and operative and postoperative follow-up (24 h post-surgery) were collected from the electronic medical files. Pain at postoperative follow-up was evaluated using the visual analog scores. The primary outcome was defined as the conversion rate from vNOTES to an alternative surgical approach.
The study population included 38 patients, of whom 13 were operated on for gender affirmation and 25 for non-gender-affirming indication. Patients in the transgender group were significantly younger (29 [25-31] vs. 42 [37-47] years; P = 0.001) than those in the comparison group. All the transgender patients were nulliparous and had been under testosterone treatment for more than a year. The median preoperative hemoglobin level was significantly higher in the transgender patients (15.50 [15.10-16.30] vs. 12.75 [11.65-14.30] g/dL; P = 0.001). The estimated blood loss was comparable between the groups (P = 0.09). None of the cases required conversion from vNOTES to an alternative approach. No extensive bleeding or organ damage was reported in any of the cases. For one patient in the transgender group, a small vaginal laceration requiring suture was documented. At 24-h postoperative follow-up, pain scores were low and comparable between the groups (P = 0.310).
Hysterectomy performed for gender affirmation by the vNOTES approach has comparable outcomes to hysterectomies done by vNOTES for other indications, with a low surgical complication rate and low self-reported pain.
描述采用经阴道自然腔道内镜手术（vNOTES）途径为变性男性实施子宫切除术作为其性别肯定性治疗一部分的结果。
这是一项在单一大学附属三级医疗中心进行的回顾性观察队列研究，纳入2022年2月至2023年4月期间所有采用vNOTES途径行子宫切除术的患者。将接受性别肯定性治疗手术的患者（暴露组）与接受其他所有适应证手术的患者（对照组）进行比较。按照妇科肿瘤学会的建议，采用vNOTES行子宫切除术并双侧输卵管切除术。从电子病历中收集患者的人口统计学、医学、妇产科病史以及手术和术后随访（术后24小时）情况。术后随访时的疼痛采用视觉模拟评分进行评估。主要结局定义为从vNOTES转换为其他手术途径的转换率。
研究人群包括38例患者，其中13例因性别肯定性治疗接受手术，25例因非性别肯定性适应证接受手术。变性组患者明显比对照组患者年轻（29[25 - 31]岁对42[37 - 47]岁；P = 0.001）。所有变性患者均未生育，且接受睾酮治疗超过一年。变性患者术前血红蛋白水平中位数明显更高（15.50[15.10 - 16.30]对12.75[11.65 - 14.30]g/dL；P = 0.001）。两组间估计失血量相当（P = 0.09）。所有病例均无需从vNOTES转换为其他手术途径。所有病例均未报告大量出血或器官损伤。变性组有1例患者记录有小的阴道撕裂伤需要缝合。术后24小时随访时，疼痛评分较低且两组间相当（P = 0.310）。
采用vNOTES途径为性别肯定性治疗实施的子宫切除术与vNOTES为其他适应证实施的子宫切除术结果相当，手术并发症发生率低，自我报告的疼痛程度低。
