Abstract
To perform a stepwise development of the surgical method for robotics-assisted laparoscopy in donor hysterectomy for uterus transplantation (UTx), a unique treatment for absolute uterine-factor infertility. Prospective observational study. University hospital. Eight donors, aged 38-62 years, underwent surgery for retrieval of the uterus and vasculature. Robotics-assisted laparoscopy was performed in donors for 6-7 h with video recording. Conversion to laparotomy was performed for last parts of retrieval surgery. Description, evaluation, and timing of 12 specific surgical steps, as well as surgical outcomes and complications. There was a progression during the course of eight surgeries. In the initial two cases, seven and six items were completed with robotics compared with all 12 items in the last three procedures. The passive surgical time decreased from ∼20% in the first four cases to ∼8% in the last three procedures. The estimated median (range) blood loss, total surgical time, and length of hospital stay were, respectively, 125 mL (100-600), 11.25 h (10-13), and 5.5 days (5-6). Two reversible complications occurred: One patient acquired pressure alopecia, and one developed pyelonephritis. The study demonstrates a clear evolution of a strategy toward fully robotic donor surgery in UTx. This is likely to become the main approach in donor surgery of live UTx donors. NCT02987023.
Highlights
Uterus transplantation has during the past decade evolved from a basic-science research project (16) aimed at a future infertility treatment for women with A bsolute uterine-factor infertility (AUFI) into a clinical procedure, still at a clinical experimental stage
The first report on use of robotic surgery in UTx was a publication from China, reporting a fully robotic retrieval of the uterus for UTx from a mother to the daughter (12)
The authors describe difficulties when attempting to dissect the deep uterine veins, and instead the utero-ovarian veins were isolated to be used as effluents of blood flow after transplantation into the recipient
Summary
To perform a stepwise development of the surgical method for robotics-assisted laparoscopy in donor hysterectomy for uterus transplantation (UTx), a unique treatment for absolute uterine-factor infertility. Robotics-assisted laparoscopy has been gradually introduced as an alternative to conventional laparoscopy and laparotomy in retrieval surgery of live kidney donors (10) and is used in the kidney transplantation procedure itself (11). The first scientific report of robotics-assisted surgery in the setting of UTx was a single case of live-donor UTx performed in China with published follow-up for 12 months (12). In the present study we first demonstrate a step-by-step and structural developmental approach to evolve and assess robotics-assisted donor hysterectomy, including harvesting of the deep uterine veins, in the complete donor cohort of the Swedish robotics UTx trial.
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