Abstract Introduction The objective of this work is to present a safe, simple, and effective alternative to traditional excisional vaginectomy for trans-masculine patients undergoing genital gender-affirming surgery. Conventional excisional methods are associated with significant blood loss, high transfusion rates, and postoperative complications, yet remain widely used due to the lack of standardized, well-described alternatives. This study introduces a trans-perineal approach involving limited excision (3 cm), electrocautery vaporization of the remaining canal, and suture closure over a wound drain. Objective We aim to describe this technique in detail, evaluate its clinical outcomes, and outline postoperative management strategies that contribute to consistently low complication rates. Methods Intra-op video and illustration-based description of our surgical technique and standard and customized instruments. Clinical outcomes for all consecutive GAS vaginal canal dissections performed over a 7-year period are reported. We require patients have had hysterectomy 2.5 months beforehand. With a speculum in place we use a ball-tip Bovie, set to 70-CUT, to vaporize, with the patient in steep Trendelenburg. Persistent bleeding is controlled with a 5-0 PDS figure-of-eight using a Stratt needle-driver. We leave a 15 Fr round drain in place and close the canal with 5-6 2-0 PDS Sutures. We leave the drain for 7-10 days, till output is 2 cc for 48 hrs. Results A total of 166 consecutive vaginectomies were performed at our GAS center. Our complications: Blood transfusion: 2/166 cases (1.2%).; Last consecutive 142 cases: 0%) Rectal injury: 0/166 (0%). Urinary tract injury: 0/166 (0%) Bowel Injury: 0/166 (0%). Mucocele (requiring surgical revision): 3/166 (1.8%) Conclusions Our anatomy-based technique affords an exceedingly low complication rate, and is simple, safe, and obviates the need for lap/robotic approaches. The simplicity of this technique makes it more accessible to centers with limited resources. Importantly, patients are better-served by avoiding un-necessary lap surgery. Disclosure No
Garcia et al. (Mon,) studied this question.
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