ROBOTIC-ASSISTED LIVING DONOR HYSTERECTOMY - TECHNIQUE AND OUTCOME (DALLAS UTERUS TRANSPLANT STUDY)

Abstract

To share our experience in performing the first series of robotic-assisted living donor hysterectomies with transvaginal extraction of the uterine graft in the world. Our institution has performed 19 living donor hysterectomies for uterus transplantation with the first 13 cases performed with an open laparotomy technique and the last 6 cases performed with a robotic-assisted technique. This video uses footage from a robotic-assisted living donor hysterectomy to review the essential steps and techniques involved. These steps include bilateral vascular dissection of the uterine arteries from the anterior branch of the internal iliac artery, the inferior uterine veins from the uterus to the inlet in the internal iliac veins, and the superior uterine veins without compromising the outflow of the ovaries. For the procedure, a da Vinci Xi robotic platform in a 4-arm configuration, alternating between a 0° and a 30° scope was used. Bilateral ureteral stents were placed allowing for indocyanine green dye injection (retrograde injection via the Foley catheter), which facilitates the identification of the ureters during surgery. A uterine manipulator (Rumi II Koh-Efficient Uterine Manipulator; CooperSurgical, Trumbull, CT) was used for retraction of the uterus. We also review donor complications, and graft and recipient outcomes. Uterus transplantation is a proven treatment for absolute uterine factor infertility. Proof of concept was achieved with both uteri from both living and deceased donors.