Vascular pedicle lengths after hysterectomy: toward future human uterus transplantation

To estimate uterine vessel lengths and diameters recovered at radical hysterectomy to assess prospects for direct vascular anastomosis bilaterally to the external iliacs in uterus transplantation, and thereby the feasibility of live uterus donation as a future treatment of absolute uterine factor infertility.

Patients (n=19; study group) undergoing radical hysterectomy for gynecologic malignancy participated. Preoperative magnetic resonance imaging (MRI) was performed in four patients to evaluate the usefulness in estimation of vessel lengths. At hysterectomy, the uterine arteries and veins were dissected separately from the anterior divisions of the internal iliacs to their attachments to the uterine cervix. The lengths of the free vascular pedicles were measured bilaterally and the distal vessel diameters were recorded. The inter-external iliac artery distance, corresponding to distance between proposed bilateral anastomosis sites, was measured. Perioperative and postoperative outcomes were compared with 76 patients (control group) undergoing standard radical hysterectomy without particular uterine vessel dissection.

The MRI showed uterine artery lengths of 55-100 mm. The duration of surgery was slightly longer in the study group (median 297 minutes) compared with the control group (262 minutes), but with no differences in perioperative and postoperative morbidity. The lengths (median) of the free portions of the left uterine artery and vein were 68 mm and 55 mm, and the right uterine artery and vein were 65 mm and 50 mm, respectively. The inter-external iliac artery distance (median) was 90 mm.

This study demonstrates that long vascular pedicles can be obtained after selective dissections of the uterine arteries and veins without compromising postoperative recovery in a live uterine donor situation.

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