2025/05/09 by Asra Vestering, Brechje Ronkes, Brechje L. Ronkes +7
Medicine · #Colorectal Cancer Surgical Treatments #Minimally Invasive Surgical Techniques #Colorectal Cancer Screening and Detection
paper · pdf · doi:10.1080/26895269.2025.2498749
Background Colpectomy involves removing the vaginal epithelium to reduce dysphoria and minimize complications of phallo- or metoidioplasty with urethral lengthening. Vaginal colpectomy is a complex surgery and carries a high complication risk. Robotic-assisted laparoscopic colpectomy (RaLC), performed without prior hysterectomy, has not been studied until now.Aim To evaluate the surgical outcomes and safety of RaLC compared to vaginal colpectomy in transmasculine and gender-diverse individuals post-hysterectomy.Methods A single-center prospective cohort pilot study (2021–2024) included 31 patients undergoing RaLC. Outcomes were compared to a retrospective cohort of 170 vaginal colpectomy patients. The primary outcome was the complication rate (Clavien-Dindo classification). Secondary outcomes included blood loss, operating time, hospital stay, and voiding function, with a follow-up of 3 months.Results Severe complications (grade ≥3a) occurred in 12.9% of the RaLC group and 18.2% of the vaginal cohort (OR 0.7 [0.2–2.0]). Intraoperative complications were fewer in the RaLC group (3.2% vs. 12.2%). postoperative complication rates were comparable (41.9% vs. 42.4%). Median intraoperative blood loss was significantly lower in the RaLC cohort (50 ml [IQR 20–50]) versus the vaginal cohort (300 ml [IQR 200–450], p < 0.001). Operating time was shorter for RaLC (85 min [IQR 79–97]) versus vaginal colpectomy (114 min [IQR 89–141]).Conclusion RaLC showed lower intraoperative blood loss, shorter operating times, and a trend toward fewer intraoperative complications compared to vaginal colpectomy. RaLC remains a complex procedure with significant postoperative risks. Further studies with larger cohorts are warranted.