Simplification of the uterus retrieval for transplantation: robotic-assisted approach and the graft outflow using ovarian veins
Abstract
Objective: An analysis of assumptions and current results of a robotic-assisted approach to minimize the surgical morbidity and maintain the postoperative quality of life in living donors of uterus undergoing graft retrieval for transplantation. Design: Review article.
Setting: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and Hospital Bulovka, Prague and Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. Methods: Literature search using the Web of Science, Google Scholar and Pubmed databases with keywords: absolute uterine factor infertility, donor surgery, living donor, robotic-assisted hysterectomy and, uterus transplantation, and an analysis of the articles published in peer-reviewed journals with impact factor.
Results: The experience with open, laparoscopic and robotic-assisted nerve-sparing radical hysterectomies to maintain the quality of life in women undergoing surgery confirms the need to preserve hypogastric and pelvic splanchnic nerves, including the vesical branches of the pelvic plexus. Precise robotic dissection of the ureters and uterine arteries should prevent injury to these nerve structures even in the procurement of the uterus for transplantation.
It should help to the reduction of postoperative side effects as the bladder and rectum evacuation disorders as well as sexual dysfunction in the living donors of uterus. The preparation of uterine veins is the most difficult, time-consuming and worst predictable part of the uterine retrieval.
In comparison, the preparation of the ovarian veins is technically simpler as well as effective in venous outflow from the uterine graft. Conclusion: The simplification of the technique of uterine graft retrieval in the living donor should be one of the basic steps to introduce uterine transplantation as a causal treatment of infertility in women without uterus.
Robotic-assisted procurement of the uterus and, moreover, the use of venous outflow from the graft exclusively via ovarian veins could contribute to the higher availability of the uterine transplantation, particularly due to a better reproducibility of the procurement surgeries in the living donors.