Mats Brännström1, Niclas Kvarnström2, Klaus Groth3, Randa Akouri3, Lennart Wiman3, Anders Enskog4, Pernilla Dahm-Kähler3. 1. Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Stockholm IVF-EUGIN, Stockholm, Sweden. Electronic address: mats.brannstrom@obgyn.gu.se. 2. Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. 3. Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. 4. Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Abstract
OBJECTIVE: 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. DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): Eight donors, aged 38-62 years, underwent surgery for retrieval of the uterus and vasculature. INTERVENTION(S): 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. MAIN OUTCOME MEASURE(S): Description, evaluation, and timing of 12 specific surgical steps, as well as surgical outcomes and complications. RESULT(S): 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. CONCLUSION(S): 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. CLINICAL TRIAL REGISTRATION NUMBER: NCT02987023.
OBJECTIVE: 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. DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): Eight donors, aged 38-62 years, underwent surgery for retrieval of the uterus and vasculature. INTERVENTION(S): 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. MAIN OUTCOME MEASURE(S): Description, evaluation, and timing of 12 specific surgical steps, as well as surgical outcomes and complications. RESULT(S): 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. CONCLUSION(S): 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. CLINICAL TRIAL REGISTRATION NUMBER: NCT02987023.
Authors: Jean Marc Ayoubi; Marie Carbonnel; Niclas Kvarnström; Aurelie Revaux; Marine Poulain; Sarah Vanlieferinghen; Yves Coatantiec; Mathilde Le Marchand; Morgan Tourne; Paul Pirtea; Renaud Snanoudj; Morgan Le Guen; Pernilla Dahm-Kähler; Catherine Racowsky; Mats Brännström Journal: Front Surg Date: 2022-06-28