open access

Vol 92, No 7 (2021)
Review paper
Published online: 2021-05-26
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Robot-assisted donor hysterectomy in uterus transplantation — a modality to increase reproducibility

Roman Chmel Jr.12, Zlatko Pastor1, Marta Novackova1, Roman Chmel1
·
Pubmed: 34105758
·
Ginekol Pol 2021;92(7):528-531.
Affiliations
  1. Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
  2. Faculty of Medicine in Plzeň, Charles University, Czech Republic

open access

Vol 92, No 7 (2021)
REVIEW PAPERS Gynecology
Published online: 2021-05-26

Abstract

Uterus transplantation is a non-lifesaving vascularized composite allotransplantation procedure requiring immunosuppression until removal of the graft. The focus of uterus transplantation is changing regarding refining individual treatment procedures included in this complex treatment of absolute uterine factor infertility, such as robot-assisted donor hysterectomy. The inferior hypogastric nerve plexus should be preserved during robotic dissection of the ureter and uterine vessels to prevent postoperative complications such as urine and fecal evacuation disturbances and sexual disorders. As most uterus transplantations have been performed in living donor concepts, robot-assisted donor hysterectomy should contribute to increased availability of uterus transplantation, particularly because it uses the precise blood-less technique of surgical dissection in the deep pelvis and has cosmetic benefits among living donors.

Abstract

Uterus transplantation is a non-lifesaving vascularized composite allotransplantation procedure requiring immunosuppression until removal of the graft. The focus of uterus transplantation is changing regarding refining individual treatment procedures included in this complex treatment of absolute uterine factor infertility, such as robot-assisted donor hysterectomy. The inferior hypogastric nerve plexus should be preserved during robotic dissection of the ureter and uterine vessels to prevent postoperative complications such as urine and fecal evacuation disturbances and sexual disorders. As most uterus transplantations have been performed in living donor concepts, robot-assisted donor hysterectomy should contribute to increased availability of uterus transplantation, particularly because it uses the precise blood-less technique of surgical dissection in the deep pelvis and has cosmetic benefits among living donors.

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Keywords

robot-assisted surgery; hysterectomy; uterus; transplantation; living donor

About this article
Title

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

Journal

Ginekologia Polska

Issue

Vol 92, No 7 (2021)

Article type

Review paper

Pages

528-531

Published online

2021-05-26

Page views

876

Article views/downloads

657

DOI

10.5603/GP.a2021.0052

Pubmed

34105758

Bibliographic record

Ginekol Pol 2021;92(7):528-531.

Keywords

robot-assisted surgery
hysterectomy
uterus
transplantation
living donor

Authors

Roman Chmel Jr.
Zlatko Pastor
Marta Novackova
Roman Chmel

References (15)
  1. Brännström M, Diaz-Garcia C, Hanafy A, et al. Uterus transplantation: animal research and human possibilities. Fertil Steril. 2012; 97(6): 1269–1276.
  2. Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014; 101(5): 1228–1236.
  3. Fageeh W, Raffa H, Jabbad H, et al. Transplantation of the human uterus. International Journal of Gynecology & Obstetrics. 2002; 76(3): 245–251.
  4. Puntambekar S, Telang M, Kulkarni P, et al. Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant. J Minim Invasive Gynecol. 2018; 25(4): 571–572.
  5. Puntambekar S, Telang M, Kulkarni P, et al. Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients. J Minim Invasive Gynecol. 2018; 25(4): 622–631.
  6. Chmel R, Novackova M, Janousek L, et al. Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations. Am J Transplant. 2019; 19(3): 855–864.
  7. Chmel R, Pastor Z, Matecha J, et al. Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020; 164(1): 115–120.
  8. Novackova M, Pastor Z, Chmel R, et al. Urinary tract morbidity after nerve-sparing radical hysterectomy in women with cervical cancer. Int Urogynecol J. 2020; 31(5): 981–987.
  9. Brännström M, Dahm-Kähler P, Kvarnström N. Robotic-assisted surgery in live-donor uterus transplantation. Fertil Steril. 2018; 109(2): 256–257.
  10. Fornalik H, Fornalik N. Uterus transplantation:robotic surgeon perspective. Fertil Steril. 2018; 109(2): 365.
  11. Wei Li, Xue T, Tao KS, et al. 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(2): 346–356.e1.
  12. Johannesson L, Koon EC, Bayer J, et al. Dallas UtErus Transplant Study: Early Outcomes and Complications of Robot-assisted Hysterectomy for Living Uterus Donors. Transplantation. 2021; 105(1): 225–230.
  13. Brännström M, Dahm-Kähler P, Kvarnström N, et al. Live birth after robotic-assisted live donor uterus transplantation. Acta Obstet Gynecol Scand. 2020; 99(9): 1222–1229.
  14. Brännström M, Kvarnström N, Groth K, et al. Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial. Fertil Steril. 2020; 114(5): 1097–1107.
  15. Testa G, McKenna GJ, Gunby RT, et al. First live birth after uterus transplantation in the United States. Am J Transplant. 2018; 18(5): 1270–1274.

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