Donor robotic-assisted laparoscopy for uterus transplantation

Abstract

Objective: Uterine transplantation has proven to be a viable solution in cases of absolute uterine factor infertility. Performing uterine explant surgery is one of the most difficult gynecologic surgical challenges owing to the complexity of the uterine vascular system. The goal of this video is to demonstrate uterine explant surgery and highlight the critical anatomy involved in this procedure.

Design: In this video, we display, narrate, and illustrate key portions of right pelvic dissection, which was subsequently performed bilaterally to achieve hysterectomy from a living donor for the purpose of uterine transplantation.

Setting: University hospital.

Patient(s): The donor was a 39-year-old woman, and the receptor sister suffers from Rokitansky syndrome. A careful right site pelvic dissection was visualized in this operation during a hysterectomy with the aim of performing a uterine graft implantation in a living donor (Research Ethics Committee and the Assistance Ethics Committee of Hospital Clínic de Barcelona [HCB/2016/0111] and Bioethics Committee of Catalunya Study included in ClinicalTrials.org registry [NCT04314869]).

Intervention(s): The donor's surgery was performed entirely using robotic surgery (DaVinci Xi, Intuitive Survival Inc.).

Main outcome measure(s): Assessment of uterine graft transplant viability.

Result(s): Good quality arterial and venous pedicles were obtained during the surgery. The difficulty of this procedure is the extensive vascular dissection that has to be done to isolate the veins that drain the uterus until the hypogastric vein.

Conclusion(s): Pelvic anatomy dissection for obtaining the graft from the donor in uterus transplantation is complex, and robotic-assisted laparoscopic surgery may help to provide a clear and more precise visualization.

Keywords: Uterine transplant anatomy; pelvic anatomy; robotic surgery.