Graft Hysterectomy After Uterus Transplantation With Robotic-assisted Techniques

Finotti, Michele; Testa, Giuliano; Koon, E. Colin; Johannesson, Liza

doi:10.1097/tp.0000000000004695

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Uterus transplantation is a temporary transplant, and graft hysterectomy (GH) is planned either at the time of delivery or at a later date [50,62]. While GH is usually performed with a traditional open approach, Finotti et al [64] recently presented the first two cases of robotic GH in UTx. The advantages of a robotic technique are a better control of hemostasis, better operative field vision particularly useful in the presence of adhesions, and superior intraoperative maneuverability, together with less postoperative pain and a shorter length of stay [64].…”

Section: Recipientmentioning

confidence: 99%

“…While GH is usually performed with a traditional open approach, Finotti et al [64] recently presented the first two cases of robotic GH in UTx. The advantages of a robotic technique are a better control of hemostasis, better operative field vision particularly useful in the presence of adhesions, and superior intraoperative maneuverability, together with less postoperative pain and a shorter length of stay [64]. Brucker et al [65] reported the first successful laparoscopic GH three months after delivery in a young LD-UTx recipient who had developed an impaired renal function with bilateral hydronephrosis during pregnancy.…”

Section: Recipientmentioning

confidence: 99%

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Living-Donor Uterus Transplantation: A Clinical Review

Veroux,

Scollo,

Giambra

et al. 2024

JCM

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Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother’s sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer–Rokitansky–Küster–Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.

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Section: Recipientmentioning

confidence: 99%

Section: Recipientmentioning

confidence: 99%

Living-Donor Uterus Transplantation: A Clinical Review

Veroux,

Scollo,

Giambra

et al. 2024

JCM

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Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Testa,

McKenna,

Wall

et al. 2024

JAMA

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ImportanceUterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy.ObjectiveTo determine whether uterus transplant is feasible and safe and results in births of healthy infants.Design, Setting, and ParticipantsA case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019.InterventionThe uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure.Main Outcomes and MeasuresUterus graft survival and subsequent live births.ResultsOf 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.Conclusions and RelevanceUterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children.Trial RegistrationClinicalTrials.gov Identifier: NCT02656550

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