背景和目标:跨性别者被定义为性别认同与出生时的性别不完全匹配的个体。性别手术通常代表治疗过程中决定性和不可逆转的步骤,特别是对生殖领域的影响。人们对性别焦虑的认识提高,医疗和手术选择的范围不断扩大,包括微创技术,促使变性手术的社会影响逐渐增加。有几种“性别分配”的手术技术,比如阴道,开腹手术,腹腔镜,和机器人,以及经阴道自然腔道内镜手术进行子宫切除术和双侧输卵管卵巢切除术(BSO)的新颖方法。这篇综述的目的是评估性别重新分配的各种手术方法(子宫切除术和附件-卵巢切除术),以确定在临床实践中女性对男性人群在手术结果方面的最佳选择,例如手术时间,手术并发症,医院出院,术后疼痛,和出血。材料与方法:本系统综述包括2007年至2024年的研究。特别考虑了记录男女重新分配手术的特征和管理的文章。最后,这篇综述包括了8篇论文。结果:文献分析考虑了从传统手术到创新方法的手术技术,如阴道自然腔道内镜手术和机器人辅助腹腔镜子宫切除术。经阴道自然腔道内镜手术和机器人方法提供了潜在的好处,例如减少术后疼痛和缩短住院时间。虽然经阴道自然腔道内镜手术可能会遇到挑战,由于狭窄的通道和较小的阴道尺寸,机器人单部位子宫切除术可能面临器械冲突。结论:传统的腹腔镜入路仍被广泛应用,证明安全性和有效性。总的来说,这篇综述强调了性别确认的外科技术的不断发展,并强调了个性化方法以满足变性患者的特定需求的必要性。
Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for \"gender assignment\", such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this
review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic
review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this
review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this
review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.