Ovarian Tissue Transplantation Using Autologous Platelet-Rich Plasma: Step-By-Step Surgical Technique
Stefano Ferla1, Rossella Vicenti2, Marisol Doglioli3
1Division of Gynecologic Oncology, Humanitas San Pio X, Via Francesco Nava, Milano, Italy (Drs. Ferla); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Ferla and Doglioli).
Study Objective:
In recent years, demand for fertility preservation has risen with improved cancer survival and awareness of post-treatment quality of life. Ovarian tissue cryopreservation(OTC) is a well-established strategy to preserve endocrine and reproductive function in women undergoing gonadotoxic therapies. Post-treatment transplantation of cryopreserved ovarian tissue(OTT) can restore endocrine activity, in up to 95% of cases and fertility, with many live births documented [1,2]. However, a major limitation of this approach is the follicular loss occurring shortly after reimplantation, which significantly reduces graft efficiency and longevity [3]. Platelet-rich plasma(PRP) is currently used in several medical fields with encouraging results, and some applications have also shown promising effects in gynecology [4].
Design:
A recent pilot study by our group demonstrated its safety and feasibility, suggesting that PRP may accelerate early graft functional recovery [5]. In this video, we aim to demonstrate the step-by-step technique for PRP OTT.
Setting:
Academic hospital. A 38-year-old woman with prior Hodgkin lymphoma undergoing laparoscopic OTT. Written informed consent was obtained from the patient prior to the procedure.
Interventions:
Diagnostic exploration of the abdomen was performed. The ovaries were exposed and a longitudinal incision was made to create a small parenchymal cavity. Similarly, 1-cm peritoneal pockets were made on each side of the pelvis after identifying the course of the ureter and hypogastric nerve. Ovarian tissue fragments, combined with gelified autologous-PRP(aPRP) were implanted into ovarian cavities and peritoneal pockets, and secured with sutures.
Conclusions:
The procedure was completed in 54 minutes with an uneventful perioperative course, and the patient was discharged on postoperative day one. The OTT restored endocrine function, normalizing gonadotropin levels and resuming the menstrual cycle within three months, without the need for hormonal replacement. Laparoscopic OTT with aPRP is safe and feasible. A phase-II trial(NCT06261658) is underway at our center to evaluate the long-term impact of PRP on endocrine and reproductive outcomes after OTT.
