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They need to have had two psychological approvals - where experts deem they should have the surgery - before surgeons assess whether they are fit enough for it. They must also have lived as a woman for at least 18 months, had hormone therapy for 12 months, and changed their first name legally by deed poll. The video shows how the patient is first placed lying on the operating table flat on their back with their feet turned outwards. A catheter is placed in their urethra to drain urine and collect the fluid.