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INTRODUCTION: Persons assigned female gender at birth may seek hysterectomy as part of their gender affirmation. Little is known about the characteristics and outcomes of this population. METHODS: Retrospective chart review of 15 trans men (female-to-male transgender persons), age 16-43, who underwent hysterectomy by a single surgeon at our academically-affiliated community hospital from 2012-2016. Three patients participated in a focus group aimed at optimizing perioperative care. RESULTS: All patients were nulliparous, 93% had been on testosterone therapy and most had previously undergone bilateral mastectomy (“top surgery”). 66% underwent surgery solely for gender affirmation, the remainder had additional gynecologic indications. Most had robotic laparoscopic hysterectomy, with or without removal of the cervix, tubes and ovaries. Mean duration of surgery was 121.5 minutes (SD 18.75) and EBL was 43 cc (SD 21.9). Mean uterine weight was 91.7 g (SD 47.69). Forty percent of patients had pelvic pathology noted intra-operatively and 46% stayed overnight with mean length of stay of 15.75 hours (SD 1.75). One patient had postoperative vaginal bleeding from introital lacerations requiring two separate re-operations. Access to the vagina was frequently challenging due to absence of prior vaginal intercourse and marked vaginal atrophy due to high dose testosterone. Focus group discussion identified opportunities for creating a welcoming, trans-competent atmosphere for this population. CONCLUSION: Regardless of their future plans for genital reassignment surgery (“bottom surgery”), trans men frequently pursue hysterectomy as part of their gender affirmation. Future research is needed to characterize this population, educate providers and improve gynecologic care.

INTRODUCTION: The purpose of this study was to compare cost and outcomes between laparoscopy and robotic-assistance in women undergoing complex myomectomy.METHODS: This is a retrospective cohort study of women undergoing minimally invasive myomectomy from January 2014 to December 2014. Women with dominant myoma diameter .8 cm and/or specimen weight .250 g and/or .5 myomata removed were compared by surgical modality. RESULTS:The cohort consisted of 70 patients with 54% laparoscopic and 46% robotic myomectomies. The robotic group had lower rates of concomitant procedures (32% versus 2%, P5.014), mean (SD) specimen weights in grams (351.5 [417.6] versus 574.0 [525.5], P5.014), and mean (SD) operative time (ORT) in minutes (150 [62.9] versus 216.7 [84.8], P5.0006), but no difference in number of myomata removed (median [range] 4 [1-16] versus 4 [1-20], P5.057) or diameter of dominant myoma in centimeters (median [range] 8 [2-20] versus 10 [2-20], P5.18). Estimated blood loss (EBL) and complication rates were equivalent. The mean (SD) direct cost in dollars for robotic cases was lower (5,861.3 [2,273.9] versus 7,081.7 [3,373.5], P5.0402). Indirect costs did not differ. In a logistic regression model, cost increased with ORT, specimen weight, EBL, prior laparotomy, complications, and length of stay, but not by surgical modality.CONCLUSION: In this pilot study of expert surgeons using their preferred modality for complex myomectomy, outcomes and costs were comparable. Costs were influenced by factors that increased surgical complexity and were contained in the robotics group. This preliminary data demonstrates a potential capacity for cost containment with the use of robotic surgery.INTRODUCTION: To examine the relationships between different colpopexy approaches and pre-operative and post-operative pelvic pain. METHODS:We extracted and analyzed data from ClinformaticsÔ DataMart (CDM) which is large national commercial insurance database. Using a retrospective cohort approach, data was collected from 9,180 patients between the ages of 18-64 who underwent colpopexy between 2005 and 2012. Cases were selected using ICD-9 and CPT codes. Logistic regression analysis was performed using SAS software. Data were analyzed to determine relationships between pre-operative and post-operative pain, pain and concomitant hysterectomy and pelvic floor repairs, and pelvic pain and surgical approach.RESULTS: A total of 18,092 patients underwent colpopexy between January 2005 and May 2012. Of which, 9,180 met criteria and data from these cases was analyzed. Younger patients were more likely to have pre-operative pain. Vaginal colpopexy was associated with more postoperative pain compared to abdominal (OR 1.53, 95% CI 1.08-2.18). Concomitant hysterectomy was associated with less postoperative pain (OR 0.54, 95% CI 0.36-0.8). Concomitant vaginal repair were associated with more postoperative pain for those without prior pain (OR 1.85, 95% CI 1.21-2.83).CONCLUSION: Patients with pre-operative pain were more likely to undergo an abdominal co...

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