Uterus transplantation: animal research and human possibilities

Brännström, Mats; Díaz-García, César; Hanafy, Ashraf; Olausson, Michael; Tzakis, Andreas G.

doi:10.1016/j.fertnstert.2012.04.001

Cited by 102 publications

(64 citation statements)

References 62 publications

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“…2 UTx has been proposed as a potential solution in such cases. A large body of surgical research in animal transplant models, 3 in addition to experience in fertility-sparing oncological surgery, 4 has resulted in the development of surgical techniques that recently led to the first successful UTx in humans. 1 Reperfusion of the organ, through connection of its major blood vessels to the recipient's vasculature, is necessary to ensure long-term viability of the uterus.…”

Section: Uterine Transplantation Surgerymentioning

confidence: 99%

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

et al. 2016

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Abstract. Uterine transplantation surgery (UTx) has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of the congenital absence or surgical removal of the uterus. Successful surgical attachment of the organ and its associated vasculature is essential for the organ's reperfusion and long-term viability. Spectral imaging techniques have demonstrated the potential for the measurement of hemodynamics in medical applications. These involve the measurement of reflectance spectra by acquiring images of the tissue in different wavebands. Measures of tissue constituents at each pixel can then be extracted from these spectra through modeling of the light-tissue interaction. A multispectral imaging (MSI) laparoscope was used in sheep and rabbit UTx models to study short-and long-term changes in oxygen saturation following surgery. The whole organ was imaged in the donor and recipient animals in parallel with point measurements from a pulse oximeter. Imaging results confirmed the re-establishment of adequate perfusion in the transplanted organ after surgery. Cornual oxygenation trends measured with MSI are consistent with pulse oximeter readings, showing decreased StO 2 immediately after anastomosis of the blood vessels. Long-term results show recovery of StO 2 to preoperative levels. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Section: Uterine Transplantation Surgerymentioning

confidence: 99%

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

et al. 2016

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“…However, uterine transplantation surgery (UTn) is a potential benefit for cases where uterusloss results in AUFI. Recent results in animal models 17 have shown the development of the surgical techniques to allow the first surgeries in humans.…”

Section: Uterine Transplantation Surgerymentioning

confidence: 99%

Multispectral imaging of organ viability during uterine transplantation surgery

et al. 2014

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Uterine transplantation surgery has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of loss of the uterus. Due to the complexity of the vasculature correct reanastomosis of the blood supply during transplantation surgery is a crucial step to ensure reperfusion and viability of the organ.While techniques such as fluorescent dye imaging have been proposed to visualise perfusion there is no gold standard for intraoperative visualisation of tissue oxygenation. In this paper results from a liquid crystal tuneable filter (LCTF)-based multispectral imaging (MSI) laparoscope are described. The system was used to monitor uterine oxygen saturation (SaO 2 ) before and after transplantation. Results from surgeries on two animal models (rabbits and sheep) are presented.A feature-based registration algorithm was used to correct for misalignment induced by breathing or peristalsis in the tissues of interest prior to analysis. An absorption spectrum was calculated at each spatial pixel location using reflectance data from a reference standard, and the relative contributions from oxy-and deoxyhaemoglobin were calculated using a least squares regression algorithm with non-negativity constraints.Results acquired during animal surgeries show that cornual oxygenation changes are consistent with those observed in point measurements taken using a pulse oximeter, showing reduced SaO 2 following reanastomosis. Values obtained using the MSI laparoscope were lower than those taken with the pulse oximeter, which may be due to the latter's use of the pulsatile arterial blood signal. Future work incorporating immunological test results will help to correlate SaO 2 levels with surgical outcomes.

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“…Two different protocols are proposed: initially, one for animal models, such as sheep or non-human primates and the second one for humans after the possible success in the animal models. Specifically, the sheep and non-human models have been demonstrated to be superior models to that of the pig because the uterus has a relatively smaller size and the vasculature is of similar dimension as that of humans (10,11). The lack of experience in the field and the small number of suitable candidates for the procedure renders the need of a multicenter approach essential.…”

Section: Introductionmentioning

confidence: 99%

Possible role of DaVinci Robot in uterine transplantation

Iavazzo

Gkegkes

2015

J Turkish German Gynecol Assoc

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The first human uterine transplantation was attempted in Saudi Arabia in 2002. However, necrosis of the graft occurred 99 days after surgery; thus, the attempt failed (1) that was followed by a lot of criticism. The second case was a 21-year-old patient with Mayer-Rokitansky-Kuster-Hauser syndrome in Turkey who achieved normal cycles and an implanted embryo post transplantation (2). Moreover, recently nine women in Sweden successfully received a transplanted uterus (3). The 6-month results of the first clinical uterus transplantation trial revealed that the durations of donor and recipient surgery ranged from 10 to 13 h and from 4 to 6 h, respectively. No immediate perioperative complications occurred in any of the recipients, and after 6 months, seven uteri remained viable with regular menses. Mild rejection episodes occurred in four of these patients that were effectively reversed by corticosteroids. The two losses of grafts were because of acute bilateral thrombotic uterine artery occlusions and persistent intrauterine infection (3). The indications of uterine transplantation include women with a history of hysterectomy at a young age for malignant uterine tumors or benign diseases, such as fibroids or adenomyosis; history of emergency peripartum hysterectomy; and history of congenital uterine infertility e.g., Mayer-Rokitansky-Kuster-Hauser syndrome (4). Robotic surgery became a common technique used by gynecological surgeons over the last decade (5, 6). Three-dimensional view, improved dexterity, infiltration of a surgeon's natural tremor, and less operator fatigue are the main advantages of robot-assisted surgery (7,8). In contrast, robotic surgery has some drawbacks, among which increased costs, requirement for a larger operating room because of the bulky machinery, and necessity of a specific training for the surgical team. In the literature, only 12 cases of uterine transplantation have been described, all of which have been approached with the open technique (1-3, 9). The robot-assisted approach was never described or proposed in the field of uterus transplantation. Therefore, we suggest a new (robotic) approach in the already challenging uterine transplantation. The aim is to form a multicenter collaboration group to organize protocols in animal models as well as humans after ethical approval to clarify the possible role of da Vinci ® Robot in uterine transplantation. Two different protocols are proposed: initially, one for animal models, such as sheep or non-human primates and the second one for humans after the possible success in the animal models. Specifically, the sheep and non-human models have been demonstrated to be superior models to that of the pig because the uterus has a relatively smaller size and the vasculature is of similar dimension as that of humans (10, 11). The lack of experience in the field and the small number of suitable candidates for the procedure renders the need of a multicenter approach essential. The surgical technique should include the following steps: -Hysterectomy of ...

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Uterus transplantation: animal research and human possibilities

Cited by 102 publications

References 62 publications

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

Multispectral imaging of organ viability during uterine transplantation surgery

Possible role of DaVinci Robot in uterine transplantation

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