Thai surgeons performed the world’s first sex change operation to be filmed on Friday with more than 30 specialist doctors from around the world watching closely on video monitors.

Surgeons from the Preecha Aesthetic Institute and BNH Hospital in Bangkok operated on a male patient nicknamed “Pae” while some of the world’s leading “sex reassignment” doctors watched on wide-screen televisions.

“I’m not nervous about operating in front of all the people, but with surgery anything can go wrong,” Dr Preecha Tiewtranon said beforehand.

“It’s the only thing I’m afraid of because I want the best results,” he said.

Pae, a 27-year-old Bangkok tour guide, said he was looking forward to the surgery after living for more than 20 years with the wrong body.

“I’m going to get what I always wanted all of my life after this surgery,” Pae told reporters before being wheeled into the operating theater. “I’m not going to feel anything after I fall asleep so I won’t care who’s watching,” he said.

During the delicate three-hour operation, surgeons removed Pae’s testicles and created an artificial vaginal canal lined with the outer skin of the penis.

Doctors said the procedure was safe but there was a danger of puncturing the patient’s rectum and bladder.

Sex change surgery is already a multi-million dollar industry in Thailand, which is competing against hospitals in places such as Singapore to attract thousands of medical tourists a year.

But critics have raised concerns about the limited regulations on cosmetic surgery in the country and the open availability of strong drugs.

Unlike countries like the United States, which require patients seeking a sex change to undergo a six-month psychiatric evaluation, Thai patients need to see a psychiatrist once.

“The Thais, they never want to see the psychiatrist because to see the psychiatrist means you are insane,” Preecha said.

“It’s OK for Thai standards. We have never seen a single case that returned to us,” he said.

Preecha admitted the ready availability of heavy medication was also resulting in boys as young as 10 taking hormone pills to look more feminine.

“In Thailand you can acquire the hormone since you were young. They don’t need a prescription. Some of them start taking the drugs when they are 10 years old,” he said.

Preecha, considered the godfather of Thailand’s cosmetic surgery business after more than 25 years in the industry, said he performs sex change operations on between three and five patients a week.

About 80 per cent of his clients were foreign and largely from the United States, where sky-rocketing insurance and the threat of lawsuits have contributed to spiraling medical costs, he said.