Uterus Transplantation: Robotic Surgeon Perspective

Fornalik, Hubert; Fornalik, Nicole

doi:10.1016/j.jmig.2017.08.227

Cited by 3 publications

(7 citation statements)

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“…The UV drain blood from the caudal portions of the periuterine venous plexuses. The two types of recognized UV are the deep UV and the superficial UV 23–26 . The discriminating structure running between the deep and superficial UV is the ureter.…”

Section: Resultsmentioning

confidence: 99%

“…Occasionally, the UV may appear sufficient near the uterine body, but tapers to several minuscule tributaries near the confluence with the IIV 85 . The UV are often located both ventrally and dorsally to the ureter 23–26,28,29 . If so, one or more UV must be transected to enable the procurement of the graft without damaging the ureter.…”

Section: Resultsmentioning

confidence: 99%

“…The mean duration of open procurement of a uterine graft from an LD is 7 h 41 min ( n = 30; range 5 h 21 min to 13 h 46 min; standard deviation [SD] = 3 h 1 min). Some authors reported that robotic or laparoscopic‐assisted procurement may be advantageous in the dissection of uterine vessels in LD 9,26,93,94 …”

Section: Resultsmentioning

confidence: 99%

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Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Křístek

Johannesson

Novotný

et al. 2020

J of Obstet and Gynaecol

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Due to the novelty of uterus transplantation, data on preferable inflow and outflow of the graft are limited. This paper reviews the technique, type of vessels and the outcome. A systematic search of the PubMed database was conducted. We extracted and analyzed data on the arteries and veins utilized, types of anastomosis, types of donors, complications and the outcome. Thirty eight sources reported 51 human uterine transplantations, 10 graft thromboses and 25 live births. Inflow was established with two uterine arteries (UA) with/without the anterior division of the internal iliac artery in 62% (n = 31) of cases, two UA arteries with a segment/patch of the internal iliac artery in 34% (n = 17) of cases or two UA with a conduit in 4% of cases (n = 2). Both cases with a conduit developed thrombosis (n = 2). Arterial thrombosis/ischemia developed in 8 of the 51 cases. In 50% of cases with arterial thrombosis, atherosclerosis was identified as a possible cause. Outflow was established by two internal iliac veins with patches/segments in 27.5% of cases (n = 14) followed by two utero-ovarian veins in 25.5% (n = 13). Venous thrombosis occurred in 3 of the 51 cases. Uterine arteries with/without anterior division of the internal iliac artery were the most frequent arteries used for inflow and produced the highest patency rate. The presence of atherosclerosis and complex arterial reconstruction was associated with a high rate of arterial thrombosis. None of the veins utilized in the procedures appeared to be superior. There are insufficient data to draw a definite conclusion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Křístek

Johannesson

Novotný

et al. 2020

J of Obstet and Gynaecol

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“…UTx entails transplantation of the uterus, including the cervix, a cuff of vagina, the surrounding ligamentous and connective tissues, as well as the major blood vessels supplying and draining the uterus. Donor surgeries have been predominantly performed using a midline laparotomy approach (n = 39), while minimally invasive surgical techniques have been proposed, 57 and recently implemented in six casesfour of which were laparoscopic-assisted, while one utilised a robotic approach. 10,33,39 While unpublished, several further cases have been performed which illustrate that the transition towards the use of minimally invasive retrieval techniques is already in progress.…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…34,39 The majority of the histologically proven cases of rejection (n = 21; 88%) were mild or moderate, while three (12%) were severe. 57 The majority of episodes of rejection were successfully managed with a 3-day course of intravenous methylprednisolone, although severe episodes required the addition of antithymocyte globulin.…”

Section: Immunological Considerationsmentioning

confidence: 99%

Uterine Transplantation

Jones

Saso

Yazbek

et al. 2021

BJOG

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A uterine transplant, or womb transplant, provides a potential treatment for women who cannot become pregnant or carry a pregnancy because they do not have a womb, or have a womb that is unable to maintain a pregnancy. This is estimated to affect one in 500 women. Options for those who wish to start a family include adoption and surrogacy, but these are associated with legal, cultural, ethical and religious implications that may not be appropriate for some women and their families. A womb transplant is undertaken when the woman is ready to start a family, and is removed following the completion of their family.Womb transplants have been performed all over the world, with more than 70 procedures carried out so far. At least 23 babies have been born as a result, demonstrating that womb transplants can work. While the procedure offers a different option to adoption and surrogacy, it is associated with significant risks, including multiple major surgeries and the need to take medications that help to dampen the immune system to prevent rejection of the womb. To date there has been a 30% risk of a transplant being unsuccessful.Although the number of transplants to date is still relatively small, the number being performed globally is growing, providing an opportunity to learn from the experience gained so far. This paper looks at the issues that have been encountered, which may arise at each step of the process, and proposes a framework for the future. However, long term follow-up of cases will be essential to draw reliable conclusions about any overall benefits of this procedure.

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Evolution and Transformation of Uterine Transplantation: A Systematic Review of Surgical Techniques and Outcomes

Escandón

Bustos

Santamaría

et al. 2021

J Reconstr Microsurg

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Background Uterine transplantation (UTx) is acknowledged to be on the second (2A) of five steps of development in accordance with the staging system for the evaluation of surgical innovations. Accordingly, we aimed to systematically review the available evidence of the surgical techniques and outcomes of UTx in terms of graft survival. Methods A comprehensive search was conducted across PubMed Medline, Cochrane-EBMR, Scopus, Web of Science, and CENTRAL through November 2020. Results Forty studies, reporting 64 recipients and 64 donors, satisfied inclusion criteria. The surgical time and the estimated blood loss were 515 minutes and 679 mL for graft procurement via laparotomy, 210 minutes and 100 mL for laparoscopic-assisted graft harvest, and 660 minutes and 173 mL for robotic-assisted procedures, respectively. Urinary tract infections (n = 8) and injury to the urinary system (n = 6) were the most common donor complications. Using the donor's internal iliac system, two arterial anastomoses were performed in all cases. Venous outflow was accomplished through the uterine veins (UVs) in 13 cases, a combination of the UVs and the ovarian/uteroovarian veins (OVs/UOVs) in 36 cases, and solely through the OVs/UOVs in 13 cases. Ischemia time was 161 and 258 minutes when using living donors (LD) and deceased donors (DD), respectively. Forty-eight uteri were successfully transplanted or fulfilled the purpose of transplantation, 41 from LDs and 7 from DDs. Twenty-five and four live childbirths from LDs and DDs have been reported, respectively. Conclusion UTx is still experimental. Further series are required to recommend specific surgical techniques that best yield a successful transplant and reduce complications for donors and recipients.

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Uterus Transplantation: Robotic Surgeon Perspective

Cited by 3 publications

References 0 publications

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Uterine Transplantation

Evolution and Transformation of Uterine Transplantation: A Systematic Review of Surgical Techniques and Outcomes

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