Design: Adult TGM underwent TLH between September 2020 and March 2023. Demographic, medical (i.e., years on testosterone), and surgical data (i.e., procedure time) were collected (IRB#20200965). Pain and GD were surveyed pre-operatively and on postoperative days one, 14, and 42. General, abdominal, and genital pain, and general and genital GD were assessed with visual analogue scales from 0-10. Changes in mean pain and GD were calculated using ANOVA with repeated measures.

Setting: Hysterectomies were performed using standard laparoscopic technique by the same surgeon at a university hospital.

Patients or Participants: Thirteen participants ages 18-67 (mean=31) were included. Sixty-two (n=8) percent and 38% (n=5) of participants underwent VCC via laparoscopic or vaginal approaches.

Interventions: VCC was performed vaginally or laparoscopically using Endostitch device or via robotic approach.

Measurements and Main Results: Mean years on testosterone were 3.25 and 5.4 and mean procedure time was 125 and 113 minutes in the laparoscopic and vaginal groups, respectively (p= 0.339, p =0.292). Mean scores for general, abdominal, and genital pain were not significantly different between groups (p=.492, p=.255, p=.476). Mean scores for general and genital GD were not significantly different between groups (p=.454, p=.347).

Conclusion: Our results suggest either VCC method can be performed during TLH for TGM without differences in postoperative pain or GD, though a larger sample is needed. Surgical planning need not be limited by resource availability, surgeon experience, or cost.