Harvesting and autotransplantation of vascularized ovarian grafts: approaches and techniques

The objective of this study was to describe the different surgical approaches involved in harvesting and heterotopic autotransplantation of intact ovaries with microvascular anastomosis. Twenty-one synchronized Merino sheep underwent harvesting of their intact ovaries with vascular pedicles. Autotransplantation was performed with fresh (n = 6) and cryopreserved-thawed (C-T; n = 15) ovaries. The ovarian vessels were anastomosed to the deep inferior epigastric vessels using end-to-end (n = 8), end-to-side (n = 6) and fish-mouth modification (n = 7) techniques. Patency of the anastomosis, ischaemia time, hormonal functions and histology were evaluated. In addition, ovarian harvesting techniques in two human subjects were described. Possible autotransplantation sites in humans were suggested. In all, 33.3% (7/21) of all fresh and C-T transplants showed patency after 10 days of follow-up. Patency was observed in 5/8, 2/6 and 0/7 animals using end-to-end, end-to-side and fish-mouth modification for completion of the microvascular anastomosis respectively. Use of the fish mouth modification technique was associated with significantly higher ischaemia time compared with end-to-end (P < 0.01) and end-to-side (P = 0.05) anastomosis. A laparoscopic approach appears to be convenient for ovarian harvesting in humans. The inferior epigastric vessel is probably the most suitable heterotopic vascularizing vessel. End-to-end anastomosis yields the highest patency rate of vascularized grafts.