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Laparotomy or minimal invasive surgery in uterus transplantation: a comparison

Artikel i vetenskaplig tidskrift
Författare J. M. Ayoubi
M. Carbonnel
P. Pirtea
Niclas Kvarnström
Mats Brännström
Pernilla Dahm-Kähler
Publicerad i Fertility and Sterility
Volym 112
Nummer/häfte 1
Sidor 11-18
ISSN 0015-0282
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi
Sidor 11-18
Språk en
Länkar dx.doi.org/10.1016/j.fertnstert.201...
Ämnesord laparoscopy, minimal invasive surgery, robotic, transplantation, Uterus
Ämneskategorier Reproduktionsmedicin och gynekologi, Transplantationskirurgi

Sammanfattning

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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