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Puntambekar S, Telang M, Kulkarni P, Puntambekar S, Jadhav S, Panse M, Sathe R, Agarkhedkar N, Warty N, Kade S, Manchekar M, Parekh H, Parikh K, Desai R, Mehta M, Chitale M, Kinholkar B, Jana JS, Pare A, Sadre A, Karnik S, Mane A, Gandhi G, Kanade S, Phadke U. Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients. J Minim Invasive Gynecol 2018; 25:622-631. [PMID: 29366966 DOI: 10.1016/j.jmig.2018.01.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To report the first ever laparoscopic-assisted live donor uterus retrieval in 2 patients for uterus transplant. DESIGN Case study (Canadian Task Force classification III). SETTING Galaxy CARE Laparoscopy Institute, Pune, India. PATIENTS Two patients with absolute uterine factor infertility with their mothers as donors. INTERVENTIONS In vitro fertilization and uterine transplant. MEASUREMENTS AND MAIN RESULTS A 12-member team was formed, and approval for transplant was obtained from the institutional review board. Pretransplant, in vitro fertilization for both patients was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus and harvested vessels were retrieved by a small abdominal incision to prevent injury and infection. The uterus was transplanted in the recipients by end to side anastomosis of the harvested vessels to external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 6 months were measured. Operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. Recipient surgery time was 4 hours. There were no intraoperative or immediate postoperative complications. Both the recipients started menstruating after 34 days and 48 days, respectively, and have had 6 cycles of menses at regular intervals. Uterine artery Doppler showed good flow in both patients. Hysteroscopy-guided cervical biopsies were used as a method of surveillance of graft rejection after uterine transplant. Office hysteroscopy was done after 2 months in both patients, and hysteroscopy-guided endometrial and cervical biopsies were taken. Minimal slough was seen on the endometrium in the patient with Mayer-Rokitansky-Küster-Hauser syndrome, which was removed. Repeat hysteroscopy after 10 days showed a healthy endometrium. CONCLUSIONS Laparoscopic-assisted uterus donor retrieval is feasible and affords all the advantages of a minimally invasive technique, thereby reducing the morbidity of the procedure. It helps in better dissection of the vessels, shortens the operative time, and helps to minimize tissue handling of the harvested uterus and vessels.
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Affiliation(s)
| | - Milind Telang
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Pankaj Kulkarni
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Seema Puntambekar
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Sanjeev Jadhav
- Department of Plastic Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Mangesh Panse
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Ravindra Sathe
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Nikhil Agarkhedkar
- Department of Plastic Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Neeta Warty
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Sandesh Kade
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Manoj Manchekar
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Hirav Parekh
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Kajal Parikh
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Riddhi Desai
- Department of Obstetrics and Gynaecology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Mehul Mehta
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Mihir Chitale
- Department of General Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Bhushan Kinholkar
- Department of Medicine, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Joy Shankar Jana
- Department of Anaesthesia, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Avinash Pare
- Department of Anaesthesia, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Abhay Sadre
- Department of Nephrology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Swapnil Karnik
- Department of Pathology, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Abhay Mane
- Department of Medicine, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Giriraj Gandhi
- Department of Plastic Surgery, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Shailendra Kanade
- Department of Anaesthesia, Galaxy CARE Laparoscopy Institute, Pune, India
| | - Uday Phadke
- Department of Anaesthesia, Galaxy CARE Laparoscopy Institute, Pune, India
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Wei L, Xue T, Tao KS, Zhang G, Zhao GY, Yu SQ, Cheng L, Yang ZX, Zheng MJ, Li F, Wang Q, Han Y, Shi YQ, Dong HL, Lu ZH, Wang Y, Yang H, Ma XD, Liu SJ, Liu HX, Xiong LZ, Chen BL. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril 2017; 108:346-356.e1. [PMID: 28778283 DOI: 10.1016/j.fertnstert.2017.05.039] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To report the 12-month results of the first human uterus transplantation case using robot-assisted uterine retrieval. This type of transplantation may become a treatment for permanent uterine factor infertility. DESIGN Case study. SETTING University hospital. PATIENT(S) A 22-year-old woman with complete müllerian agenesis who underwent a previous surgery for vaginal reconstruction. The live uterine donor was her mother. INTERVENTION(S) The uterus transplantation procedure consisted of robot-assisted uterine procurement, orthotopic replacement and fixation of the retrieved uterus, revascularization, and end-to-side anastomoses of bilateral hypogastric arteries and ovarian-uterine vein to the bilateral external iliac arteries and veins. MAIN OUTCOME MEASURE(S) Data from preoperative investigations, surgery, and follow-up (12 months). RESULT(S) The duration of the donor and recipient surgeries were 6 and 8 hours, 50 minutes, respectively. No immediate perioperative complications occurred in the recipient or donor. The recipient experienced menarche 40 days after transplant surgery, and she has had 12 menstrual cycles since the surgery. No rejection episodes occurred in the recipient. CONCLUSION(S) These results demonstrate the feasibility of live-donor uterine transplantation with a low-dose immunosuppressive protocol and the role of DaVinci robotic assistance during human uterine procurement. CLINICAL TRIAL REGISTRATION NUMBER XJZT12Z06.
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Affiliation(s)
- Li Wei
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Tao Xue
- Department of Otorhinolaryngology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Kai-Shan Tao
- Department of Hepatic and Splenic Surgery, Department of Organ Transplant Centers, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Geng Zhang
- Department of Urinary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Guang-Yue Zhao
- Department of Osteology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Shi-Qiang Yu
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Liang Cheng
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Zhao-Xu Yang
- Department of Hepatic and Splenic Surgery, Department of Organ Transplant Centers, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Min-Juan Zheng
- Department of Ultrasound Diagnosis, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Qiong Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Ying Han
- Department of Gastroenterology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yong-Quan Shi
- Department of Gastroenterology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Hai-Long Dong
- Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Zhi-Hong Lu
- Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yun Wang
- Department of Ultrasound Diagnosis, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Hong Yang
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xiang-Dong Ma
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Shu-Juan Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Hai-Xia Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Li-Ze Xiong
- Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Bi-Liang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China.
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