We read with interest the recent letter by Lazard et al. on laparoscopic single port access total hysterectomy and salpingooophorectomy (THSO) for female to male transsexualism [1]. The minimal invasive approach is certainly the best option for such individuals because it reduces the aesthetic damage. However, the standard laparoscopic hysterectomy still requires three pelvic accesses in abdominal wall, a sign indicating gynecological surgery with potential psychological consequences in vulnerable patients. The recent introduction of laparoendoscopic single-site surgery (LESS) in several surgical procedures, as hysterectomy and or adnexal surgery, permits to overcome standard laparoscopic aesthetic limitations, further reducing postoperative pain and offering a more rapid return to normal activity [2,3]. The introduction of robotic surgery by using the da Vinci Surgical System (Intuitive Surgical System, Sunnyvale, CA, USA), approved by the U.S. Food and Drugs Administration in 2005, seems to represent a step further in advancing the efficiency and the performance of complex laparoscopic maneuvers and permits a minimally invasive approach in many more patients [4]. LESS surgery still presents some obstacles, in particular, the “sword fighting” among instruments, and the recent development of single-site port robotic devices represents a substantial evolution. Indeed, the insertion of surgical instruments into the abdominal cavity through the umbilical access can cause a crossing of them with a reversion of the hands and a consequent major difficulty for the surgeon. The robot plays an important role by decreasing the impact of these technical limitations and still has the advantages of LESS in term of aesthetic outcome and pain reduction. Recently, we started a pilot study with the aim to investigate the effectiveness of robotic single port hysterectomy in sex reassignment surgery. Through a 2 cm trans-umbilical incision, we introduced in abdomen cavity the single-site port, grasped just above the lower rim using an atraumatic clamp, with a descending movement within the incision. The technique used for THSO was similar to that used in standard robotic surgery. Vaginal cuff was closed both with transvaginal and laparoscopic approach. Table 1 reports the perioperative data of the first five successful cases at our Institution. To the best of our knowledge, this is the first case series of THSO described in literature by using robotic single site device in the treatment of female to male transsexualism. Stefano Bogliolo, MD, Chiara Cassani, MD, Luciana Babilonti, MD, Valentina Musacchi, MD, Rossella Elena Nappi, PhD, and Arsenio Spinillo, PhD Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy