Robot-assisted donor hysterectomy in uterus transplantation — a modality to increase reproducibility

Chmel, Roman; Pastor, Zlatko; Nováčková, Marta

doi:10.5603/gp.a2021.0052

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Two veins can be selected for removal: the utero‐ovarian vein, which requires oophorectomy in the donor, and the uterine vein. According to Brännström, the most challenging step is the removal of the uterine veins, which is associated with an elevated risk of: ureteral injury (estimated at over 20%) (Chmel et al, 2021); venous lesions and subsequent thrombosis; and a greater operating time (Brännström et al, 2014). Furthermore, cases of postoperative bladder dysfunction in the donor could be related to this operating step (Chmel et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Relationship between uterine veins, ureter, and hypogastric nerve for uterine transplantation: An anatomic study

et al. 2022

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This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ca.23850Background: Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy, venous drainage of the uterus is poorly defined in the literature. Our aim was to provide a standardized description of uterine veins through a multimodal approach to establish anatomical landmarks for the uterine transplantation surgeon.Methods: Data were obtained from: (1) an anatomical study of eight fresh female cadavers (16 hemipelves) studied separately by an extrafascial dissection from the iliac bifurcation to the uterine pedicle, with analysis of the urinary tract and nerve structures; and (2) a virtual anatomical study from the Anatomage® Table comprising a high-fidelity virtual reconstruction of two deceased female subjects by imaging and anatomical methods.Results: An inconstant duality of uterine veins was identified: a deep uterine vein of larger caliber, and a superficial uterine vein observed in 25% of cases. A close relationship of the ureter passing posterior to the superficial uterine vein and anterior to the deep uterine vein was evident in the parametrium. The inferior hypogastric plexus was identified in all cases immediately behind the deep uterine vein. The data obtained from the fresh female cadavers were validated by the Anatomage® Table . Conclusions: We describe the close relationship of the uterine veins with the ureter and the inferior hypogastric plexus. This knowledge represents a surgical landmark to support the success of uterine transplantation by respecting both the graft and the safety of the living donor by limiting the risk of injuries during uterus procurement.

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Section: Introductionmentioning

confidence: 99%

Relationship between uterine veins, ureter, and hypogastric nerve for uterine transplantation: An anatomic study

et al. 2022

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Who should provide the uterus? The ethics of live donor recruitment for uterus transplantation

Lee

2023

J Med Ethics

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Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.

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Yeni̇ Anneli̇k Düzeni̇: Eti̇k Ve Hukuki̇ Boyutlariyla Rahi̇m Nakli̇

Metin

2023

İnönü Üniversitesi Hukuk Fakültesi Dergisi

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The uterus is the reproductive organ where the embryo formed by the fertilization of the sperm and egg settles and continues its development until birth. Absolute uterine factor infertility affects 3% to 5% of infertile women of reproductive age globally. With the transition of uterus transplantation from experimental studies to clinical trials and starting to have babies in this way, uterus transplantation offers a solution that can enable these women to have children genetically on their own and grow them in their wombs. Uterine transplant is a procedure that combines both assisted reproductive technology and organ transplantation due to the necessity of in vitro fertilization and embryo freezing pre-procedure and thus represents a new level of cooperation between the two. With the transition of uterus transplantation from an experimental clinical procedure to clinical trials and its positive early results, ethical discussions applicable to each of the stakeholders in this study will be reviewed with bioethical principles and major theories. Uterine transplants are not life-saving, but life-enhancing transplants. In this context, uterus transplantation is accepted as a type of composite tissue transplantation included in the Organ and Tissue Transplant Services Regulation. However, uterus transplantation is also different from composite tissue transplantations in which it is included. By the definition of "donor" in the Composite Tissue Transplant Centers Directive in the Turkish legal system, it is accepted that living persons cannot be obliged to donate composite tissue. In this case, it is concluded that uterus transplantation is also included in the scope of composite tissue, and according to our legal order, it can only be done from a dead donor. In addition, in the Composite Tissue Transplantation Directive, uterine transplantation is not mentioned among the medical indications for such transplantations. Even this legal uncertainty points out that uterus transplants should be handled with a separate arrangement from the composite tissue transplant umbrella.

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Robot-assisted donor hysterectomy in uterus transplantation — a modality to increase reproducibility

Cited by 3 publications

References 15 publications

Relationship between uterine veins, ureter, and hypogastric nerve for uterine transplantation: An anatomic study

Relationship between uterine veins, ureter, and hypogastric nerve for uterine transplantation: An anatomic study

Who should provide the uterus? The ethics of live donor recruitment for uterus transplantation

Yeni̇ Anneli̇k Düzeni̇: Eti̇k Ve Hukuki̇ Boyutlariyla Rahi̇m Nakli̇

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