(180) DOES PRE-VAGINOPLASTY BILATERAL ORCHIECTOMY COMPROMISE SCROTAL SKIN LENGTH USING A SINGLE MEDIAN RAPHE INCISION? DESCRIPTION OF OUR SURGICAL TECHNIQUE AND INTRA & POST-OP OUTCOMES

Abstract Introduction Gender-affirming bilateral orchiectomy (GABO) has many benefits pre-vaginoplasty including lowering required feminizing hormone-therapy dosage (presumably cardiac protective), immediate elimination of Testosterone production, and, reduced dysphoria. Though there is no gold-standard GABO technique, some have questioned whether GABO through a single median-raphe incision might reduce the net area of scrotal skin available at future full-depth vaginoplasty to line the canal. Objective We aimed to: 1) Compare intraoperative scrotal skin-graft measurements and postoperative neovaginal depth among vaginoplasty patients based upon pre-vaginoplasty GABO status; and 2) Describe our own single-incision technique for GABO. Methods A single-center retrospective chart review identified transgender women undergoing vaginoplasty with neovaginal canal using penile+scrotal skin between August/2017-May/2023. Subjects were grouped based upon pre-vaginoplasty GABO with median-raphe incision, vs. orchiectomy during vaginoplasty. We measured available scrotal skin before and during vaginoplasty (tubularized length). We describe our specific technique for simple bilateral orchiectomy using a scrotal median-raphe incision. Results 57 patients were identified. 40/57 (70%) underwent bilateral orchiectomy at time of vaginoplasty (mean age 36.6 ± 12.6Y (SD)), while 17/57 (30%) underwent pre-vaginoplasty GABO (mean age 37.4 ± 12.8Y (SD)). Fig. 1 There was no statistically-significant difference in preoperative scrotal skin or intraoperative tubularized scrotal skin lengths. Our technique uses a 2.5 cm incision at the base of the penoscrotal junction, to deliver both testicles. After skeletonizing the spermatic cord, the entire cord is clamped as a single packet 2 cm from the external ring. A spermatic cord block is performed before the cord is suture-ligated twice with 0-Vicryl. Remaining hemostasis is secured with bipolar-Bovie. The skin is closed with a running 5-0 Vicryl. Mean operative-time = 29 minutes. (Full-video: https://youtu.be/t5fq-MrUKoY). Conclusions Our pre-vaginoplasty GABO technique using a single median raphe incision provides excellent access for high ligation and provides excellent cosmesis. We found no statistically-significant difference in net tubularized scrotal-skin length length or post-op vaginal depth across study groups. We offer pre-vaginoplasty GABO, by our technique, to all vaginoplasty patients facing a surgery wait-time of >4 months. Disclosure No.