Gynecologic Procedures Research Articles

Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System.

Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.

Perspectives of gynecologic oncology fellowship training and preparedness for practice

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants’ selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%–99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help.

Učestalost kontrolnih pregleda i kliničkih postupaka kod onkoloških pacijenata prije i za vrijeme pandemije bolesti Covid-19 u klinici za ženske bolesti i porode KBC-a Zagreb

Introduction. At the end of 2019, an epidemic caused by a coronavirus broke out in China. A certain number of female cancer patients neglected their regular oncology treatment during the pandemic, at first because of quarantine, and later due to their incompetence in applying online medicine. The majority of cancer patients demand permanent care and diagnostic/therapeutic procedures. The coronavirus pandemic (COVID-19) led to numerous check-up cancellations and surgery postponements in healthcare, yet it is unknown to what extent it has affected the healthcare of female cancer patients. Aim. To determine the frequency of check-ups and clinical procedures that female cancer patients underwent prior to and during the coronavirus (COVID-19) epidemic. Methods. Gathering data on the number of clinical procedures in cancer patients was conducted through the hospital information system (BIS) of the Department of Gynaecology and Obstetrics of KBC Zagreb in the period of two years. The study group included female cancer patients during one year of the pandemic (March 11, 2020 to March 11, 2021), and the control group consisted of female cancer patients during the period of one year preceding the pandemic.Results. In the Department of Obstetrics and Gynaecology of KBC Zagreb there were less laparoscopic procedures (LPSC) in 2020 than in 2019, with 24.6% less procedures administered in 2020. There were also fewer other gynaecological procedures in 2020, however, the difference was not statistically significant p>0.05. In the same period in Zagreb in 2020 there were 13.9% fewer patients treated for cancer than in 2019. Also in 2020, there were statistically significantly fewer patients treated throughout Croatia p<0.001, with a decrease of 16.3%.Conclusion. All aspects of healthcare, from diagnostics and therapy to research, have been distressed by the emergence of COVID-19. During the crisis caused by this disease, healthcare workers dealt with the problem of thorough and rapid reorganisation of the system, not only with the purpose of treating newly infected patients, but also in trying to maintain the quality of healthcare for cancer patients. The adjustment of the healthcare system with timely organisation in the Department of Obstetrics and Gynaecology managed to preserve the level of quality healthcare for its female cancer patients. For the future it would be necessary to prepare action plans which will assure adequate health care service without decreasing number of examinations.

Cosmetic gynaecology

Key content Female genital cosmetic surgery (FGCS) includes several procedures involving the labia minora, labia majora, clitoris, vagina, mons pubis and genital area; procedures may involve, for example, reduction or augmentation and be surgical or energy based. Indications for FGCS can be broadly divided into cosmetic and functional reasons. Counselling on the risks and cosmetic outcomes, as well as sexual and functional results, should be provided, and the woman's expectations discussed. Learning objectives To develop a holistic view when discussing cosmetic gynaecology concerns, including psychosexual assessment. To understand the procedures that are currently available, the evidence‐base behind these procedures, and their risks and benefits. To understand the implications of genital cosmetic surgery on patients, including their psychosexual wellbeing, and the legality of these procedures with reference to female genital mutilation (FGM). Ethical issues The ‘postcode lottery’ in commissioning cosmetic gynaecological procedures in the UK leads to the question: should they be available on the NHS? Who should be performing cosmetic gynaecological procedures: the plastic surgeons who do little vaginal surgery, or the gynaecologists? There is currently no formal training in this area for gynaecologists.

A Randomized Clinical Trial Evaluating Indigo Carmine as a Visualization Aid for Evaluating Ureteral Patency

ObjectivesTo determine whether intravenous indigo carmine provides a visualization advantage compared to saline in the evaluation of ureteral patency in a randomized, controlled clinical trial. MethodsPatients undergoing urological or gynecological surgical procedures in which the patency of the ureter was to be assessed received a saline injection and were randomized to receive 2.5 mL or 5.0 mL of indigo carmine. Blinded video assessments were conducted by independent reviewers using a conspicuity scale ranked 1 (poorest) to 5 (best), and subjects with scores ≥ 3 and at least a +1-point difference from saline were considered responders. Time to visualization was recorded for indigo carmine. A responder analysis evaluated whether indigo carmine showed improved visualization. ResultsThere were 96 ureters evaluated with the 5.0 mL dose of indigo carmine, 92 with the 2.5 mL dose, and 180 with saline. Most ureters were scored a 4 or higher on the conspicuity scale following indigo carmine; both doses were significantly better than saline (p<0.0001). Overall, 92.3% of patients were rated as a responder for either ureter. The median time to visualization of blue color was not significantly different (6.0 minutes in the 5.0 mL group and 5.9 minutes in the 2.5 mL group). There were no adverse events related to indigo carmine use. ConclusionsBoth dose levels of indigo carmine were significantly better than saline as a visualization aid for ureter patency.

Infective endocarditis of tricuspid valve following septic abortion: a case report

Introduction: Right-sided infective endocarditis (IE) in non-intravenous drug users is a rare finding. IE of the tricuspid valve is considered an important but uncommon complication in patients with a recent history of obstetric and gynecological procedures. Case presentation: We report a case of a 28-year-old female with IE of the tricuspid valve with a prior history of dilatation and curettage. The echocardiography revealed two mobile vegetation in the septal leaflet of the tricuspid valve with severe eccentric tricuspid regurgitation. Blood culture was positive for Staphylococcus aureus. The patient was started on intravenous (i.v.) antibiotics with supportive treatments and improved over the days. Clinical discussion: Infection can get access to the venous system via pelvic veins after the septic obstetric and gynecological procedure and subsequently to the right side of the heart. Different studies have highlighted the role of prophylactic antibiotics in significantly reducing post-abortal infections. In our patient, the disease was diagnosed on the basis of clinical, echocardiographic, and blood culture findings, and the patient responded well to i.v. antibiotics and supportive care under close monitoring in the coronary care unit. Conclusion: It is important for healthcare providers to be aware of the risk factors and symptoms associated with right-sided IE for early diagnosis and treatment. Appropriate antibiotic prophylaxis and adherence to sterile techniques can help to prevent IE.

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends and Perioperative Complications From 2007 to 2018 Using the NSQIP Database

(Abstracted from J Minim Invasive Gynecol 2023;30(8):627–634) One of the most common gynecological procedures performed within the United States, the trends of hysterectomy types have changed over the past 30 years, with the 1990s demonstrating predominantly abdominal hysterectomies, whereas current trends tend to favor minimally invasive hysterectomies (MIHs) using laparoscopic or vaginal routes. In addition, within the hysterectomy trend, it is notable that higher rates of abdominal hysterectomy and postoperative complications occur for Black and Hispanic women as seen across varying health care systems.

Audit of all cases of total abdominal hysterectomy (TAH) at a private hospital in Enugu, Nigeria: Indications and post-operative outcomes

Background: Hysterectomy is a major and one of the commonest gynaecological procedures performed by gynaecologists, world over. It is the surgical removal of the uterus either through the vagina or an abdominal incision. Being such a major procedure in gynaecological practice with consequences on reproduction and sexual performance, we undertook this audit in the private hospital to review its prevalence, indication and outcomes. Aim: The aim of this study was to review the indications and outcomes of all cases of TAH in a private hospital Methodology: This was a 3-year retrospective study in a private hospital in Enugu, south-east, Nigeria. Result: From the theatre register and case files of patients, it was found that a total of 58 patients had major gynaecological surgeries in the centre. Out of this total, 20 were TAH giving a prevalence of 34.5% of major gynaecological surgeries. The socio-demographic distribution of the patients shows that 12(60%) were aged between 46 and 55, 10(50%) were civil servants and 10(50%) had tertiary education. Majority of them 8(40%) were para 4, followed by para3 (20%). The major indications were symptomatic uterine fibroid, 9(45%) and abnormal uterine bleeding 8(40%). Conclusion: Total abdominal hysterectomy was a common gynaecological procedure and the major indications were symptomatic uterine fibroids and abnormal uterine bleeding. Majority of the cases were done with spinal anaesthesia and the only identifiable post-operative morbidity was anaemia.

A COMPARATIVE STUDY TO ASSESS EFFECTS OF PNEUMOPERITONEUM AND TRENDELENBURG POSITION ON HEMODYNAMICS AND VENTILATORY MECHANICS DURING TOTAL LAPAROSCOPIC HYSTERECTOMY IN OBESE AND NON-OBESE PATIENTS

Background:Hysterectomy is a common gynaecological surgical procedure, with Laparoscopic hysterectomy (LH) emerging as a favorable approach due to its benefits such as shorter recovery periods and reduced complications. However, the creation of pneumoperitoneum and the Trendelenburg position required for total laparoscopic hysterectomy (TLH) can induce significant hemodynamic and ventilatory changes. Methodology: Our study included 60 patients who were categorized into two groups of 30 each based on their BMI: non-obese (BMI &lt; 30) and obese (BMI ≥ 30). All patients underwent routine pre-anaesthesia check-up followed by general anaesthesia. Diastolic blood pressure (DBP), systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP), plateau pressure (PPLAT), peak pressure (PPEAK),and driving pressure (PDRIVING), end-tidal carbon dioxide (EtCO2) as well as static (CST) and dynamic (CDYN) lung compliance were measured at different time intervals including baseline, following induction of anaesthesia, insufflation, changing to Trendelenburg position, desufflation and after extubation. Results:The heart rate decreased on induction of anesthesia in both the groups and remained lower throughout the procedure but was statistically non-significant (p&gt;0.05). There was a rise in SBP, DBP, and MAP on insufflation and further with head-down positioning in both obese and non-obese patients, however, was statistically non-significant (p&gt;0.05). The PPEAK, PPLAT, and PDRIVING were increased on induction, following the creation of pneumoperitoneum as well as Trendelenburg position (p&lt;0.05). The values were higher in obese as compared to the non-obese. The static and dynamic compliance were lower at all time intervals in obese patients when compared to the non-obese group. Conclusion: Obese patients exhibit higher plateau pressure, peak inspiratory pressure, and driving pressure values, indicating increased airway resistance and potential ventilation challenges during surgery. Additionally, the reduced static and dynamic lung compliance values in obese patients suggest decreased lung elasticity and difficult ventilation.

Robotic Surgery in Gynaecology: A Retrospective Evaluation of an Experience at a Single Centre.

The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons' point of view. A single centre, retrospective observational study. All women who underwent robotic gynaecological surgeries between 2015 and 2022. The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data. A total of 211 robotic cases wereperformed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129min, respectively, and haemoglobin drop was 1.34 and 1.2g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic. Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.

The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii.

Traditional use of opioids to treat postoperative pain may lead to abuse and overdose. The development of Enhanced Recovery After Surgery (ERAS) protocols has helped to shift pain management from traditional methods to evidence-based best practices involving multimodal analgesia techniques. The purpose of this quality improvement project was to implement and determine the effectiveness of a standardized, evidence-based ERAS pain management pathway for patients undergoing colorectal or gynecology procedures at a medical center in Hawaii. After the intervention, the evaluation of data associated with opioid use, patients' pain scores, time spent in the postanesthesia care unit, and inpatient length of stay showed that most results were not significant. However, the ERAS pain management pathway did reduce clinical practice variations, intraoperative opioid administration, the time that patients spent in the postanesthesia care unit, and length of stay. The ERAS pain management pathway continues to be used and updated at this facility.

A review of functional and surgical outcomes of gynaecological reconstruction in the context of pelvic exenteration

BackgroundRadical surgical excision may be the only curative option for patients with advanced pelvic malignancy, but concerns surrounding the functional outcomes and survivorship of patients undergoing exenterative surgery remain. This is especially important in the context of vulvovaginal resection, where patients are often younger and surgery can have a profoundly negative impact on quality of life, body image and overall wellbeing. Reconstructive procedures are an important means of mitigating these adverse effects but outcomes are poorly described. AimTo define the outcomes associated with gynaecological reconstructive procedures following pelvic exenterative surgery and to compare them with the outcomes of those patients who did not undergo reconstruction. MethodsAn international, multicentre retrospective investigation comparing the outcomes of reconstruction with no reconstruction. The protocol was prospectively registered (NCT05074069). Results334 patients were included. 77 patients had a neovagina reconstructed, 139 patients underwent flap reconstruction and 118 were not reconstructed. Patients who underwent reconstruction had a longer operative time and hospital stay with an increased risk of minor perineal complications. Reconstruction did not confer an increased risk of surgical reintervention, and overall complication rates were equivalent. Procedure-specific major morbidity was 5.2 % and 11.5 % for neovaginal and flap reconstruction, respectively. 66 % of patients undergoing neovaginal reconstruction experienced no long term morbidity. 7 % developed neovaginal stenosis and 12 % suffered disease recurrence. ConclusionNeovaginal reconstruction is safe in carefully selected patients and offers specific advantages over alternative techniques, with few patients requiring reoperation. Primary closure does not increase perineal morbidity.

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecological emergencies

ObjectiveTransvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive approach increasingly applied to perform many gynecological procedures. Despite a still limited level of evidence, compared to conventional laparoscopy, vNOTES seems to be associated with reduced blood loss, shorter operative time, less postoperative pain, shorter hospitalization time, better cosmetic results and decreased postoperative morbidity. Although growing evidence supports the effectiveness of vNOTES for elective adnexal surgeries, there is still limited knowledge regarding its feasibility and safety in emergency settings. In the present study, we report our experience performing vNOTES in gynecological emergency cases. Study designWe prospectively collected and analyzed data from patients who underwent vNOTES for gynecological emergencies between November 2021 and June 2023. Demographic and perioperative characteristics were collected and analyzed. ResultsSeventeen patients were included. Interventions were realized for suspicion of ectopic pregnancy in 7 cases (41.2%), for suspicion of adnexal torsion in 7 cases (41.2%), for post-hysterectomy hemoperitoneum in 2 cases (11.8%), and for uncontrollable uterine bleeding in 1 case (5.9%). Emergency procedures included unilateral salpingectomy (35.3%), ovarian cystectomy (23.5%), ovarian cystotomy (17.6%), adnexal detorsion (11.8%), hemoperitoneum drainage (11.8%), hysterectomy (5.9%), and appendectomy (5.9%). The overall median operative time was 38 [18–72] minutes. The median estimated intraoperative blood loss was 30 [5−150] mL, and no intraoperative complications occurred. Conversion to conventional laparoscopy or laparotomy was never needed. Patients stayed hospitalized for a median time of 30 [4−144] hours after the intervention. The median visual analog scale value for postoperative pain evaluation was 2 [0−5] at 12, 24, and 48 postoperative hours. No complications associated with the procedure occurred. ConclusionsThis study demonstrated the feasibility of performing vNOTES procedures for managing gynecological emergencies such as tubal ectopic pregnancy, adnexal torsion, painful ovarian lesions, post-hysterectomy hemoperitoneum, and uncontrollable uterine bleeding. Associated with data reported in the available literature, our results suggest potential benefits in treating gynecological emergencies by vNOTES over conventional laparoscopy. However, stronger evidence from larger studies is needed to confirm it.

Not Just Non-Consensual Pelvic Exams

Not Just Non-Consensual Pelvic Exams

Full robotic cholecystectomy: first worldwide experiences with HUGO RAS surgical platform.

The Hugo RAS™ system (Medtronic, Minneapolis, MN, USA), approved for gynaecological and urological procedures, has been recently certified for the use in few general surgeries. Only bariatric and colorectal procedures have been described so far. Here, we report the first worldwide experience with three cases of full-robotic cholecystectomies with the Hugo RAS™ system. A description of the operative room setup, of the docking angles and details of the procedures is reported. Docking time was 12, 10, and 6 min, respectively. The total operative time was 105 min in the first case, 100 min in the second and 88 in the third case. Intra- and post-operative courses were uneventful. With this pre-defined set up, the innovative conformation of Hugo RAS™ system can safely allow performing full robotic cholecystectomy avoiding the need for additional ports.

Urological Injuries After Gynecological Surgical Interventions

Urological injuries are an uncommon but critical concern in gynecological surgery, carrying the potential for severe complications. This bibliographic review provides a comprehensive examination of urological injuries in the context of gynecological procedures. The article explores their epidemiology, clinical importance, theoretical framework, including their definition, types of injuries, complications, and management. The discussion section highlights emerging approaches and future directions in urological injury management. In conclusion, the article emphasizes the significance of vigilance, prevention, and interdisciplinary collaboration to enhance patient safety in gynecological surgery.

Management of venous thromboembolism as a complication after Total laparoscopic hysterectomy with bilateral salpingectomy: A case report

Total laparoscopic hysterectomy (TLH) is a common procedure in gynecology, often performed to treat various gynecologic conditions. This case report presents a patient who underwent TLH with bilateral salpingectomy and subsequently developed a pulmonary embolism (PE) postoperatively. The patient, a 49-year-old woman with a history of adenomyosis and abnormal uterine bleeding (AUB) associated with endometrial hyperplasia – AUB-M, developed difficulty breathing and chest pain two days after surgery. Diagnostic tests revealed acute PE affecting both main pulmonary arteries. The patient received prompt medical treatment in the intensive care unit (ICU), including anticoagulation therapy, diuretics, oxygen support, and antibiotics. Her condition gradually improved, and she was discharged on oral anticoagulation medication after five days. The case highlights the importance of considering venous thromboembolism (VTE) as a potential complication, even in low-risk patients, and the need for further research to identify additional risk factors and improve preoperative care to prevent such life-threatening complications.

Patient’s Satisfaction with Use of Spinal Anaesthesia for Day-Case gynaecological procedures

Background: Patient Satisfaction is defined as the individual’s positive evaluation of a distinct dimension of care. Satisfaction is positive when the perception of the care given meets pateints’ level of expectation. The ideal anaesthesia for ambulatory procedures should provide a rapid and smooth onset of action, good intraoperative analgesia, good operating condition, short recovery time free from side effect and high level of patient satisfaction. Patient satisfaction is a vital part of assessing quality of care, and different instruments have been developed to measure it without a consensus on an ideal one. Achieving high satisfaction among patients that undergo day case gynaecological procedures under spinal would promote the acceptance of this anaesthetic technique in our locality. Method: This was an observational prospective study in which ninety (90) patients aged 18 – 45 years with ASA class I or II scheduled for day case gynaecological procedures were recruited. Spinal anaesthesia was given in sitting position using a range of 7.5mg to 10mg of 0.5% hyperbaric bupivacaine. The procedures lasted less than one (1) hour, during which the haemodynamic parameters (SBP, DBP MAP Pulse rate, and Spo2) were monitored continually. Patients were discharged home on the same day of procedure. Two days following the procedure, a structured questionnaire on patient’s satisfaction level was administered via phone call and data collected included satisfaction with explanation of the anaesthesia for the procedure, postoperative complications and overall level of satisfaction, and acceptance of spinal anaesthesia in the future. Results: Outcome showed that 88 patients (97.8%) were overall satisfied with the use of spinal anaesthesia for Day case gynaecological procedures and 2 patients (2.2%) were not satisfied with the anaesthetic technique used for the procedure. All the patients accepted to use spinal anaesthesia for similar procedure in the future.

A CLINICAL PROFILE AND RISK FACTORS IN VENTRAL HERNIA PATIENTS: A RETROSPECTIVE STUDY

Introduction: About 4% of all hernia patients admitted to the ward had ventral hernias. Obesity, wound infections, malnutrition, immunosuppression, and inappropriate suture materials or incorrect suture placement were important causative factors for ventral hernia. Methods: This retrospective study was carried out among 50 patients of ventral hernias. Data were compiled in a pre-designed proforma using information from clinical notes, discharge summaries, and operation notes. This study excluded patients under the age of 18, those with femoral, inguinal, or posterior abdominal wall hernias. Results: The most common subtype of ventral hernia was incisional hernia (54.0%). The most common presenting symptom was swelling only (60.0%). The most common associated risk factor was obesity (36.0%) and constipation (26.0%). About 48.0% hernia occurred following gynecological procedures (hysterectomy - 22.0%, lower segment cesarean section - 8.0%, and tubectomy - 8.0%). Conclusion: The most common ventral hernia is the incisional hernia, which often occurs after obstetric and gynecological surgeries. Surgical site infection, obesity, and constipation increase the risk of ventral hernias.

Gender-affirming hysterectomy in the United States: A comparative outcomes analysis and potential implications for uterine transplantation.

Hysterectomy is a gynecological procedure sometimes performed as part of the gender-affirming process for transgender and gender-expansive patients assigned female at birth. Our goal was to compare surgical outcomes between patients undergoing gender-affirming hysterectomy and patients undergoing hysterectomy for benign menstrual disorders. We then explored the implications of gender-affirming hysterectomy for uterine transplantation. We performed a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2009 through 2018. We identified patients undergoing hysterectomy in the United States based on Current Procedural Terminology code. We used the International Classification of Diseases 9 or 10 codes to identify patients with benign menstrual disorders (non-gender-affirming group) and gender dysphoria (gender-affirming group). We compared patient characteristics and surgical complications. Of the 40,742 patients that met inclusion criteria, 526 (1.3%) patients were individuals with gender dysphoria. Compared to patients who underwent hysterectomy for benign menstrual disorders, gender-affirming patients were younger, were healthier, had a lower prevalence of diabetes, and were more likely to undergo surgery in the outpatient setting, with shorter time to discharge. Complication rates were similar between groups. Logistic regression controlling for the American Society of Anesthesiology classification determined the difference of return to the operating room was not statistically significant (OR 1.082; 95% CI, 0.56-2.10; p = 0.816). Gender-affirming hysterectomy has a safety profile similar to hysterectomy performed for benign menstrual disorders. Researchers should further explore the possibility of uterus donation among these patients as they may be suitable candidates.