Surgical Technique For Pelvic Floor Transplantation.

Abstract

Fecal and urinary incontinence (FUI) is a current public health problem with enormous social and economic impact. Treatments for FUI are insufficient. After anatomic investigation we perceived pelvic floor as an en block composite tissue sharing a common vascular pedicle (external iliac) and neuronal trunk (pudenda). In this report we describe pelvicfloor transplantation in male and female cadaver. Donor operation - A combined perineal and abdominal incision are performed. The dissection progress between the leg root tissues and pelvic floor near the pelvic ring and pudendal nerves and vessels are divided allowing the total pelvic floor mobilization - (1A, 1B).Figure: No Caption available.Through the abdominal incision, the genital organs, bladder and rectum are mobilized. The aorta and vena cava are isolated up to the renal vessel and down to the iliac bifurcation preserving the external iliac vessels. The aorta and vena cava are sectioned by the renal vessels to preserve the spermatic vessels. The graft -[Figure 1](1C, 1D) containing skin, muscular complex, ligaments, bladder (B), ureter (UR), vagina (V) or penile (P), rectum (R), anus (A), uterus (UT), ovarian (O), testis (T) and its ducts (D) is removed. Recipient operation - The same donor's perineal and abdominal incision and dissection strategies were performed. The external iliac vessels including rectal vessels and pudendal nerves are divided and the en block pelvic floor tissues are removed. The infrarenal aorta and vena cava were isolated, the graft was positioned in the abdomen and an end to side aorta-aorta and cava-cava anastomosis were performed. We also performed anastomosis between donor and recipient ureter, rectum and pudenda nerves and vessels. The pelvic floor was repositioned in its original position by stitches between pelvic floor ligaments, pudendal nerves and vessels, peritoneum and skin, completing the operation -[Figure 1](1E, 1F). Conclusion. In this survey we show that pelvic floor transplantation surgery is feasible. This innovation is an open door for ethical, physiological, anatomic and surgical debate.