Standardization of back-table technique for uterus transplantation

Area of Science:

• Reproductive Medicine and Surgery
• Transplantation Surgery
• Gynecology

Background:

• Uterus transplantation (UTx) is a viable option for absolute uterine factor infertility, with over 100 cases performed globally.
• Successful UTx relies on meticulous graft preparation, including back-table procedures, which are critical for graft survival and function.
• Existing literature lacks detailed focus on standardized back-table techniques in gynecological transplantation.

Purpose of the Study:

• To present a standardized, step-by-step back-table technique for uterus transplantation (UTx).
• To provide a detailed surgical video demonstrating the back-table preparation process.
• To offer educational content to facilitate the initiation of UTx programs at other institutions.

Main Methods:

• Detailed description of a standardized back-table preparation protocol for uterine grafts.
• Includes organ perfusion, vascular preparation (arteries and veins), and meticulous suturing of the vagina and cervix.
• Highlights critical steps such as vessel conjoining for small diameters and assessing vessel positioning to prevent torsion.

Main Results:

• The described back-table technique resulted in no surgical complications in the presented cases.
• The uterine graft was successfully implanted, leading to a successful pregnancy outcome.
• Patients experienced an uneventful postoperative course with early mobilization and a short hospital stay (5 days).

Conclusions:

• The standardized back-table technique effectively minimizes harm to the recipient during uterus transplantation.
• This technique preserves uterine graft function, contributing to successful pregnancy outcomes.
• Widespread adoption of UTx can be further supported by continued educational content, particularly video-based resources.