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 Aug;108(2):346-356.e1. doi: 10.1016/j.fertnstert.2017.05.039.

Abstract

Objective: To report the 12-month results of the first human uterus transplantation case using robot-assisted uterine retrieval. This type of transplantation may become a treatment for permanent uterine factor infertility.

Design: Case study.

Setting: University hospital.

Patient(s): A 22-year-old woman with complete müllerian agenesis who underwent a previous surgery for vaginal reconstruction. The live uterine donor was her mother.

Intervention(s): The uterus transplantation procedure consisted of robot-assisted uterine procurement, orthotopic replacement and fixation of the retrieved uterus, revascularization, and end-to-side anastomoses of bilateral hypogastric arteries and ovarian-uterine vein to the bilateral external iliac arteries and veins.

Main outcome measure(s): Data from preoperative investigations, surgery, and follow-up (12 months).

Result(s): The duration of the donor and recipient surgeries were 6 and 8 hours, 50 minutes, respectively. No immediate perioperative complications occurred in the recipient or donor. The recipient experienced menarche 40 days after transplant surgery, and she has had 12 menstrual cycles since the surgery. No rejection episodes occurred in the recipient.

Conclusion(s): These results demonstrate the feasibility of live-donor uterine transplantation with a low-dose immunosuppressive protocol and the role of DaVinci robotic assistance during human uterine procurement.

Clinical trial registration number: XJZT12Z06.

Keywords: DaVinci Robota; Infertility; human; uterine factor infertility; uterine transplantation.

Publication types

  • Case Reports

MeSH terms

  • 46, XX Disorders of Sex Development / surgery*
  • Congenital Abnormalities / surgery*
  • Female
  • Humans
  • Hysterectomy / methods*
  • Mullerian Ducts / abnormalities*
  • Mullerian Ducts / surgery
  • Ovary / blood supply*
  • Ovary / transplantation
  • Reconstructive Surgical Procedures / methods
  • Robotic Surgical Procedures / methods*
  • Treatment Outcome
  • Uterus / transplantation*
  • Veins / transplantation*
  • Young Adult

Supplementary concepts

  • Mullerian aplasia