Uterus transplantation:robotic surgeon perspective

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Oncology
• Transplant Surgery

Background:

• Traditional uterine harvesting via laparotomy is associated with significant donor morbidity and lengthy procedures.
• Nerve-sparing radical hysterectomy is technically challenging, often not performed via laparotomy in the US.

Purpose of the Study:

• To evaluate the safety and feasibility of robotic dissection of deep pelvic vessels for uterine transplantation.
• To assess the robotic technique's application in live donor uterine harvesting.
• To demonstrate modifications improving transplant blood supply and outflow.

Main Methods:

• Application of a robotic platform for precise dissection of internal iliac artery and vein branches, including uterine vessels.
• Surgical video documentation of the procedure in two patients undergoing robotic nerve-sparing radical hysterectomy.
• Focus on dissection of deep pelvic vessels crucial for uterine transplantation.

Main Results:

• Robotic dissection achieved superior precision, hemostasis, and efficiency in managing pelvic vessels.
• The technique allows for harvesting intact uterine vessels with internal iliac artery and vein patches.
• Demonstrated potential for improved transplant blood supply and outflow.

Conclusions:

• Robotic dissection of deep pelvic vessels is a safe and feasible approach for uterine harvesting.
• The robotic technique offers advantages over laparotomy, potentially enhancing transplant survival and donor outcomes.
• Requires experienced robotic surgical teams skilled in deep pelvic vessel anatomy and dissection.