Mats Brännström1,2, Pernilla Dahm-Kähler1, Niclas Kvarnström3, Randa Akouri1, Karin Rova2, Michael Olausson3, Klaus Groth1, Jana Ekberg3, Anders Enskog4, Mona Sheikhi2, Johan Mölne5, Hans Bokström1. 1. Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2. IVF-EUGIN, Stockholm, Sweden. 3. Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 5. Department of Clinical Pathology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Abstract
INTRODUCTION: The proof-of-concept of uterus transplantation, as a treatment for absolute uterine factor infertility, came with the first livebirth after uterus transplantation, which took place in Sweden in 2014. This was after a live donor procedure, with laparotomy in both donor and recipient. In our second, ongoing trail we introduced robotic-assisted laparoscopic surgery of the donor to develop minimal invasive surgery for this procedure. Here, we report the surgery and pregnancy behind the first livebirth from that trial MATERIAL AND METHODS: The case of the present study, within a prospective observational study, includes a 62-year-old mother as uterus donor, and a 33 year-old daughter with uterine absence as part of the Mayer-Rokitansky-Küster-Hauser syndrome, as recipient. Donor surgery was mainly done by robotic-assisted laparoscopy, involving dissections of the utero-vaginal fossa, arteries, and ureters. The last part of surgery was by laparotomy. Recipient laparotomy included vascular anastomoses to the external iliac vessels. Data relating to in vitro fertilization, surgery, follow-up, obstetrics and postnatal growth are presented RESULTS: Three in vitro fertilization cycles prior to transplantation gave 12 cryopreserved embryos. The surgical time of the donor in the robot was 360 min, according to protocol. The durations for robotic surgery for dissections of the utero-vaginal fossa, arteries, and of ureters were 30, 160 and 84 minutes, respectively. The remainder of donor surgery was by laparotomy. Recipient surgery included preparations of the vaginal vault, three end-to-side anastomoses (one arterial, two venous) on each side to the external iliacs and fixation of the uterus. Ten months after transplantation, one blastocyst was transferred and resulted in pregnancy, which proceeded uneventful until elective cesarean section in week 36+1. A healthy boy (Apgar 9-10-10) was delivered. Follow-up of child has been uneventful for 12 months CONCLUSIONS: This is the first report of livebirth after use of robotic-assisted laparoscopy in uterus transplantation and is thereby a proof-of-concept of use of minimal invasive surgery in this new type of transplantation. This article is protected by copyright. All rights reserved.
INTRODUCTION: The proof-of-concept of uterus transplantation, as a treatment for absolute uterine factor infertility, came with the first livebirth after uterus transplantation, which took place in Sweden in 2014. This was after a live donor procedure, with laparotomy in both donor and recipient. In our second, ongoing trail we introduced robotic-assisted laparoscopic surgery of the donor to develop minimal invasive surgery for this procedure. Here, we report the surgery and pregnancy behind the first livebirth from that trial MATERIAL AND METHODS: The case of the present study, within a prospective observational study, includes a 62-year-old mother as uterus donor, and a 33 year-old daughter with uterine absence as part of the Mayer-Rokitansky-Küster-Hauser syndrome, as recipient. Donor surgery was mainly done by robotic-assisted laparoscopy, involving dissections of the utero-vaginal fossa, arteries, and ureters. The last part of surgery was by laparotomy. Recipient laparotomy included vascular anastomoses to the external iliac vessels. Data relating to in vitro fertilization, surgery, follow-up, obstetrics and postnatal growth are presented RESULTS: Three in vitro fertilization cycles prior to transplantation gave 12 cryopreserved embryos. The surgical time of the donor in the robot was 360 min, according to protocol. The durations for robotic surgery for dissections of the utero-vaginal fossa, arteries, and of ureters were 30, 160 and 84 minutes, respectively. The remainder of donor surgery was by laparotomy. Recipient surgery included preparations of the vaginal vault, three end-to-side anastomoses (one arterial, two venous) on each side to the external iliacs and fixation of the uterus. Ten months after transplantation, one blastocyst was transferred and resulted in pregnancy, which proceeded uneventful until elective cesarean section in week 36+1. A healthy boy (Apgar 9-10-10) was delivered. Follow-up of child has been uneventful for 12 months CONCLUSIONS: This is the first report of livebirth after use of robotic-assisted laparoscopy in uterus transplantation and is thereby a proof-of-concept of use of minimal invasive surgery in this new type of transplantation. This article is protected by copyright. All rights reserved.
Authors: Arvind Manikantan Padma; Laura Carrière; Frida Krokström Karlsson; Edina Sehic; Sara Bandstein; Tom Tristan Tiemann; Mihai Oltean; Min Jong Song; Mats Brännström; Mats Hellström Journal: NPJ Regen Med Date: 2021-05-21