Feminizing genitoplasty is a complex surgical procedure that involves the aesthetic and functional modification of the genitalia in line with a person's female identity. This procedure presents several extra-surgical challenges, including adequate case selection, counseling and informed consent, interdisciplinary work in preoperative preparation and postoperative rehabilitation. The challenges in the operating room are also significant. These include maintaining the prolonged forced lithotomy position, developing the rectoprostatic plane to create the neovagina, controlling intraoperative bleeding, managing surgical time, and addressing possible complications
This report aims to describe the impact of integrating an advanced bipolar vessel sealing device (ABVSD) on the duration of surgery, intraoperative bleeding, and hospital stay for female transgender patients undergoing genital surgery.

This retrospective observational study analyzed patients who underwent feminizing genitoplasty by the same surgeon between 2021 and 2023 in two centers. The data were collected from clinical records and operative protocols of both centers. The sample size was 59, which included all patients operated on by the same surgical team during the study period at these two centers. The surgical technique employed was modified penoscrotal inversion. Anaesthesia was administered through a combination of epidural and general anesthesia. The data was analyzed using non-parametric statistics in Stata SE 17.0 software, based on the number of cases.

Of all the patients, 62.7% (37) operated without using the ABVSD and 37.3% (22) operated using the ABVSD. The average age of the group operated on without ABVSD was 29.8 years, and for the group operated on with LABVSD it was 31 years. No significant differences were found in relation to the time of hormone therapy prior to surgery (p=0.88). The non ABVSD group had a mean of 4.3 years (SD 2.2) while the ABVSD group had a mean of 5.1 years (SD 5.2).

The most frequent comorbidity in the sample was HIV infection (10.16%), with no difference between groups (p=0.39). Mental health pathologies (8.4%) were the second most frequent comorbidity. The sample's mean body mass index was 23.7 (SD 3.3), and there was no significant difference between the two groups (p=0.55).

The mean duration of surgery was 5.99 hours (SD 0.76) in the non-ABVSD group, and 5.55 hours (SD 0.70) in the ABVSD group. The difference was statistically significant (p value = 0.028). The difference between the two groups was also significant (p value = 0.020).

In terms of intraoperative bleeding, the non-ABVSD  group had an average blood loss of 502 ml (SD 231.5 ml), while the ABVSD group had an average blood loss of 365 ml (SD 118.9 ml).

In terms of hospitalization duration, the non-ABVSD group had an average stay of 7.7 days (SD 2.23), while the ABVSD group had an average stay of 3.8 days (SD 0.81), with a statistically significant difference (p value < 0.001). It is important to note that the length of hospitalization is influenced not only by the clinical course, but also by the postoperative management protocol of each institution. 

The incidence of complications was 10.8% (4) in the non-ABVSD group and 9% (2) in the ABVSD group, with no significant difference between the two groups (p=1.0).

Results of this research are consistent in demonstrating that the integration of an advanced bipolar vascular sealing device (ABVSD) in the duration of surgery, intraoperative bleeding and hospital stay in female transsexual patients undergoing genital surgery.
However, the limitations of this study are the small sample size and follow-up time of the patients.

In this series, the use of an advanced bipolar vessel sealing device was associated with a shorter operative time, less intraoperative bleeding, and a shorter hospital stay.