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Laparotomy or minimal invasive surgery in uterus transplantation: a comparison

Journal article
Authors J. M. Ayoubi
M. Carbonnel
P. Pirtea
Niclas Kvarnström
Mats Brännström
Pernilla Dahm-Kähler
Published in Fertility and Sterility
Volume 112
Issue 1
Pages 11-18
ISSN 0015-0282
Publication year 2019
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 11-18
Language en
Links dx.doi.org/10.1016/j.fertnstert.201...
Keywords laparoscopy, minimal invasive surgery, robotic, transplantation, Uterus
Subject categories Obstetrics, Gynecology and Reproductive Medicine, Transplantation surgery

Abstract

Uterus transplantation (UTx) is the first available treatment for absolute uterine factor infertility, a condition due to absence of the uterus or presence of a non-functional uterus. The proof-of-concept of UTx as an infertility treatment for this group of patients occurred in 2014 in Sweden by the first birth after human UTx. That and subsequent cases of the Swedish trial were live-donor UTx procedures with laparotomy of both donor and recipient. Although results of the initial Swedish clinical UTx trial were very favorable in terms of take-home-baby rate, the drawback was the long duration (>10 h) of donor surgeries and associated long recovery periods. There exist three later publications, with uterus procurements from live donors by laparotomy with a range of surgical durations of 5.3 hours to 13 hours. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. The principle of these UTx trials is to use modern concepts of robotic-assisted laparoscopy primarily in the live donor. There also exists a small number of published UTx procedures with donor surgery by partial conventional laparoscopy and one published case with total robotic-assisted laparoscopy procedure. This review discusses open versus minimal invasive surgery in relation to the accumulated knowledge in the field. Moreover, we propose some future directions for the development of this surgery in UTx. © 2019

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