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Uterus transplantation:robotic surgeon perspective
Hubert Fornalik1, Nicole Fornalik1
1Goshen Center for Cancer Care, Goshen, Indiana.
Objective:
To study the safety and feasibility of robotic dissection of deep pelvic vessels as applied to the robotic harvesting of a uterus from live transplant donor.
Design:
Surgical video.
Setting:
Gynecologic oncology practice of a tertiary community cancer center.
Patient(S):
Two patients undergoing robotic nerve-sparing radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 cervical cancer.
Intervention(S):
Application of robotic platform to precise dissection of internal iliac artery and vein, their branches, including the superficial and deep uterine artery and vein. The robotic technique for deep pelvic dissection in gynecologic oncology demonstrated here provides superior outcomes compared with the open technique. In our settings, a typical robotic nerve-sparing radical hysterectomy takes 3 hours from completion of the pelvic lymphadenectomy to the moment when the patient leaves the operating room.
Main Outcome Measure(S):
Safety and adequacy of robotic dissection of deep pelvic vessels. The procedure's modification to the current technique demonstrated improved transplant blood supply and outflow. Demonstration of modification to current technique, that has potential to improve transplant blood supply and outflow.
Result(S):
Using the robotic technique for nerve-sparing radical hysterectomy, the pelvic vessels can be dissected with superior precision, hemostasis, efficiency, and clinical outcomes. Due to its difficulty, nerve-sparing radical hysterectomy is not even performed via a laparotomy approach in the United States. Robotic dissection allows for better exposure of the pelvic vessels, which may allow for harvesting intact uterine vessels with internal iliac artery and vein patches, thus facilitating wider vascular anastomosis and superior blood supply and outflow of the transplant.
Conclusion(S):
Uterine harvesting from a live donor is currently being performed via a laparotomy technique, resulting in long procedures associated with significant morbidity. Based on our gynecologic oncology experience, a robotic approach to deep pelvic dissection is superior to laparotomy. Robotic nerve-sparing radical hysterectomy is a difficult procedure that requires knowledge of deep pelvic vessels' anatomy, precise dissection techniques, and repetition. Robotic harvesting of the uterus for transplantation from a live donor may provide better results in terms of transplant survival and donor outcomes. This type of procedure should be attempted by a robotic team that has experience in working with deep and large pelvic vessels.
