(Poster 97) Outcomes of Gender-affirming Hysterectomy Vaginectomy by Surgical Approach

Objectives: To compare perioperative outcomes of gender-affirming laparoscopic hysterectomy with total vaginectomy with and without robot assistance.

Methods: This was a single center retrospective cohort study of patients who underwent gender-affirming combined hysterectomy and total vaginectomy procedures. At our institution the standard surgical approach to hysterectomy-vaginectomy changed in early 2023 from a combined laparoscopy-vaginal to combined robot-assisted-vaginal approach. Prior to 2023, the entire vaginectomy portion was done transvaginally after the laparoscopic hysterectomy. In 2023, the laparoscopic hysterectomy and upper 2/3rds of the vaginectomy were done robotically, with the distal 1/3 completed transvaginally. We sought to compare these two groups. We evaluated perioperative outcomes such as estimated blood loss (EBL), length of surgery, as well as patient demographics and comorbidities. Chi-squared and student’s t-test were used for statistical comparisons and a p value of .05 was used to indicate statistical significance. Multivariable linear regression models with EBL and length of surgery as dependent outcomes were developed to adjust for potential confounders.

Results: Between October 2015 and March 2025, 105 patients underwent gender-affirming hysterectomy-vaginectomy of which 40 were done with robot-assistance and 65 were done laparoscopically. Comorbidities were similar, however, age and BMI were statistically different between groups (Table 1). When comparing robot-assisted hysterectomy-vaginectomy with laparoscopic hysterectomy-vaginectomy, mean EBL was significantly lower in the robot-assisted group (281 ± 133 mL vs. 404 ± 306 mL, p = 0.006). Other outcomes of interest were not significantly different, including length of surgery (258 ± 45 minutes for robot-assisted vs. 271 ± 46 minutes for laparoscopic, p = 0.16). Multivariate linear regression models revealed that robotic-assisted procedures resulted in a significantly lower blood loss (114 mL) compared to laparoscopic procedures with adjustment for age, BMI, hypertension and diabetes. A second linear regression model with length of surgery as the outcome did not reveal a difference in length of surgery by surgical approach.

Conclusions: This retrospective study demonstrates a lower mean EBL with robot-assisted gender affirming hysterectomy-vaginectomy when compared to laparoscopy, with no significant increase in length of surgery.