Skip to main content

Advertisement

SpringerLink
Log in

Procedures and technical considerations of robotic-assisted human uterus transplantation

  • Guidelines and Position Statements
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Uterus transplantation is the only treatment for absolute uterine factor infertility. Complex vascular anatomy, long operation time, and intraoperative injuries are the main factors that limit progress in uterus transplantation. Moreover, robot-assisted uterus transplantation is not popular at present due to technical difficulties, with only a few countries reporting success.

Methods

In this paper, we present the key technical points of robot-assisted uterine transplantation by analyzing and summarizing our surgical experience and other successful cases of robot-assisted uterine transplantation. This study provides an evidence-based reference for clinicians planning robot-assisted uterine transplantation procedures.

Conclusion

Minimally invasive technologies can shorten the operation time, reduce injuries, and contribute to analyzing the anatomy of complex blood vessels. Therefore, robot-assisted uterine transplantation is an important direction for the future of uterine transplantation, and the findings and procedures reported herein contribute to the standardization and promotion of robot-assisted uterine transplantation operations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Brännström M (2015) Uterus transplantation. Curr Opin Organ Transplant 20:621–628

    Article  PubMed  Google Scholar 

  2. Hammond BN (2019) UK criteria for uterus transplantation: a review. BJOG Int J Obstet Gynaecol 126:1320–1326

    Article  Google Scholar 

  3. Da Graca B, Johannesson L, Testa G, Wall A (2021) Uterus transplantation: ethical considerations. Curr Opin Organ Transplant 26:664–668

    Article  PubMed  Google Scholar 

  4. Kvarnström N, Enskog A, Dahm-Kähler P, Brännström M (2019) Live versus deceased donor in uterus transplantation. Fertil Steril 112:24–27

    Article  PubMed  Google Scholar 

  5. Petrini C, Morresi A (2017) Uterus transplants and their ethical implications. Ann Ist Super Sanita 53:25–29

    PubMed  Google Scholar 

  6. Zitkute V, Kvietkauskas M, Leber B, Strupas K, Stiegler P, Schemmer P (2020) Ischemia and reperfusion injury in uterus transplantation: a comprehensive review. Transplant Rev 34:100550

    Article  Google Scholar 

  7. Malasevskaia I, Al-Awadhi AA (2021) A new approach for treatment of woman with absolute uterine factor infertility: a traditional review of safety and efficacy outcomes in the first 65 recipients of uterus transplantation. Cureus 13:e12772

    PubMed  PubMed Central  Google Scholar 

  8. Kristek J, Johannesson L, Novotny R, Kachlik D, Fronek J (2020) Human uterine vasculature with respect to uterus transplantation: a comprehensive review. J Obstet Gynaecol Res 46:2199–2220

    Article  PubMed  Google Scholar 

  9. Fornalik H, Fornalik N (2018) Uterus transplantation: robotic surgeon perspective. Fertil Steril 109:365

    Article  PubMed  Google Scholar 

  10. Tardieu A, Dion L, Collinet P, Ayoubi JM, Garbin O, Agostini A, Aubard Y, Piver P, Lavoue V, Gauthier T (2019) Uterus transplantation: questions and future prospects. J Gynecol Obstet Hum Reprod 48:1–3

    Article  PubMed  Google Scholar 

  11. Sullivan OOE, Reilly OBA (2012) Robot-assisted surgery:—impact on gynaecological and pelvic floor reconstructive surgery. Int Urogynecol J 23:1163–1173

    Article  Google Scholar 

  12. Wei L, Xue T, Tao K, Zhang G, Zhao G, Yu S, Cheng L, Yang Z, Zheng M, Li F, Wang Q, Han Y, Shi Y, Dong H, Lu Z, Wang Y, Yang H, Ma X, Liu S, Liu H, Xiong L, Chen B (2017) Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril 108:346-356.e1

    Article  PubMed  Google Scholar 

  13. Huang Y, Ding X, Chen B, Zhang G, Li A, Hua W, Zhou D, Wang X, Liu D, Yan G, Zhang C, Zhang J (2020) Report of the first live birth after uterus transplantation in People’s Republic of China. Fertil Steril 114:1108–1115

    Article  PubMed  Google Scholar 

  14. Vieira MA, Souza C, Nobrega L, Reis R, Andrade C, Schmidt R, Carvalho L (2021) Uterine transplantation with robot-assisted uterus retrieval from living donor: first case in Brazil. J Minim Invasive Gynecol 28:1817

    Article  PubMed  Google Scholar 

  15. Brännström M, Kvarnström N, Groth K, Akouri R, Wiman L, Enskog A, Dahm-Kähler P (2020) Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial. Fertil Steril 114:1097–1107

    Article  PubMed  Google Scholar 

  16. Johannesson L, Koon EC, Bayer J, McKenna GJ, Wall A, Fernandez H, Martinez EJ, Gupta A, Ruiz R, Onaca N, Testa G (2021) Dallas UtErus transplant study: early outcomes and complications of robot-assisted hysterectomy for living uterus donors. Transplantation 105:225–230

    Article  PubMed  Google Scholar 

  17. Johannesson L, Wall A, Putman JM, Zhang L, Testa G, Diaz GC (2019) Rethinking the time interval to embryo transfer after uterus transplantation –DUETS (Dallas UtErus transplant study). BJOG Int J Obstet Gynaecol 126:1305–1309

    Article  CAS  Google Scholar 

  18. Caplan A, Purves D (2017) A quiet revolution in organ transplant ethics. J Med Ethics 43:797–800

    Article  PubMed  Google Scholar 

  19. Fageeh W, Raffa H, Jabbad H, Marzouki A (2002) Transplantation of the human uterus. Int J Gynaecol Obstet 76:245–251

    Article  CAS  PubMed  Google Scholar 

  20. Brucker SY, Strowitzki T, Taran FA, Rall K, Scholler D, Hoopmann M, Henes M, Guthoff M, Heyne N, Zipfel S, Schaffeler N, Bosmuller H, Fend F, Rosenberger P, Heim E, Wiesing U, Nikolaou K, Fleischer S, Bakchoul T, Poets CF, Goelz R, Wiechers C, Kagan KO, Kramer B, Reisenauer C, Oberlechner E, Hubner S, Abele H, Dahm-Kahler P, Kvarnstrom N, Brannstrom M, Nadalin S, Wallwiener D, Konigsrainer A (2020) Living-donor uterus transplantation: pre-, intra-, and postoperative parameters relevant to surgical success, pregnancy, and obstetrics with live births. J Clin Med 9:2485

    Article  PubMed  PubMed Central  Google Scholar 

  21. Taran FA, Scholler D, Rall K, Nadalin S, Konigsrainer A, Henes M, Bosmuller H, Fend F, Nikolaou K, Notohamiprodjo M, Grasshoff C, Heim E, Zipfel S, Schaffeler N, Bakchoul T, Heyne N, Guthoff M, Kramer B, Reisenauer C, Hoopmann M, Kagan KO, Brannstrom M, Wallwiener D, Brucker SY (2019) Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study. Fertil Steril 111:186–193

    Article  PubMed  Google Scholar 

  22. Johannesson L, Testa G, Flyckt R, Farrell R, Quintini C, Wall A, O’Neill K, Tzakis A, Richards EG, Gordon SM, Porrett PM (2020) Guidelines for standardized nomenclature and reporting in uterus transplantation: an opinion from the United States uterus transplant consortium. Am J Transplant 20:3319–3325

    Article  PubMed  Google Scholar 

  23. Richards EG, Farrell RM, Ricci S, Perni U, Quintini C, Tzakis A, Falcone T (2021) Uterus transplantation: state of the art in 2021. J Assist Reprod Genet 38:2251–2259

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jones BP, Saso S, Bracewell Milnes T, Thum MY, Nicopoullos J, Diaz Garcia C, Friend P, GhaemMaghami S, Testa G, Johannesson L, Quiroga I, Yazbek J, Smith JR (2019) Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG Int J Obstet Gynaecol 126:1310–1319

    Article  CAS  Google Scholar 

  25. Puntambekar S, Puntambekar S, Telang M, Kulkarni P, Date S, Panse M, Sathe R, Agarkhedkar N, Warty N, Kade S, Manchekar M, Chitale M, Parekh H, Parikh K, Mehta M, Kinholkar B, Jana JS, Pare A, Kanade S, Sadre A, Hardikar S, Jathar A, Bakre T, Chate M, Tiruke R (2019) Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol 26:628–635

    Article  PubMed  Google Scholar 

  26. Brännström M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, Diaz-Garcia C, Hanafy A, Lundmark C, Marcickiewicz J, Gäbel M, Groth K, Akouri R, Eklind S, Holgersson J, Tzakis A, Olausson M (2014) First clinical uterus transplantation trial: a six-month report. Fertil Steril 101:1228–1236

    Article  PubMed  Google Scholar 

  27. Kisu I, Banno K, Mihara M, Lin LY, Tsuji K, Yanokura M, Hara H, Araki J, Iida T, Abe T, Kouyama K, Suganuma N, Aoki D (2012) Indocyanine green fluorescence imaging for evaluation of uterine blood flow in cynomolgus macaque. PLoS ONE 7:e35124

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Puntambekar S, Telang M, Kulkarni P, Puntambekar S, Jadhav S, Panse M, Sathe R, Agarkhedkar N, Warty N, Kade S, Manchekar M, Parekh H, Parikh K, Desai R, Mehta M, Chitale M, Kinholkar B, Jana JS, Pare A, Sadre A, Karnik S, Mane A, Gandhi G, Kanade S, Phadke U (2018) Laparoscopic-assisted uterus retrieval from live organ donors for uterine transplant: our experience of two patients. J Minim Invasive Gynecol 25:622–631

    Article  PubMed  Google Scholar 

  29. Carbonnel M, Dahm-kähler P, Revaux A, Brännström M, Ayoubi J (2020) Adapting surgical skills from robotic-assisted radical hysterectomy in cervical cancer to uterine transplantation: a look to an optimistic future! J Robot Surg 14:841–847

    Article  PubMed  Google Scholar 

  30. Tummers P, Goker M, Dahm-Kahler P, Brannstrom M, Tullius SG, Rogiers X, Van Laecke S, Weyers S (2019) Meeting report: first state-of-the-art meeting on uterus transplantation. Transplantation 103:455–458

    Article  PubMed  Google Scholar 

  31. Flyckt R, Farrell R, Falcone T, Tullius SG, Brannstrom M, Dahm-Kahler P, Tzakis A (2020) Meeting report: second world congress of the international society of uterus transplantation Cleveland. Transplant 104:1312–1315

    Article  Google Scholar 

Download references

Funding

This work was supported by General project of national Natural Science Foundation of China (Grant Numbers 81672583).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Medical University127 Changle West Road, Xincheng District, Xi’an, China

    Lianghao Zhai, Jian Dong, Li Wei, Fuxing Zhou & Biliang Chen

Authors
  1. Lianghao Zhai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fuxing Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Biliang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LZ: Data Collection, Manuscript writing. JD: Data collection. LW: Data management, Manuscript writing. FZ: Manuscript writing. BC: Project development. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by FZZ, JD and LW. The first draft of the manuscript was written by LZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Biliang Chen.

Ethics declarations

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled “Procedures and technical considerations of robotic-assisted human uterus transplanta”. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Xijing Hospital of Air Force Military Medical University (No:XJLL(2014)0055).

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2 and 3.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhai, L., Dong, J., Wei, L. et al. Procedures and technical considerations of robotic-assisted human uterus transplantation. Arch Gynecol Obstet 307, 643–651 (2023). https://doi.org/10.1007/s00404-022-06791-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-022-06791-y

Keywords

Search

Navigation