Surgical Technique in Preparation of Recipient
This chapter provides details on surgical preparations of the recipient before uterus transplantation. In both deceased and live donor uterus transplantation, the recipient should be surgically prepared so that the uterus can be brought into the pelvis of the recipient, as soon as the graft is prepared at the back-table. A synchronized preparation of the recipient will minimize the cold ischemic time of the organ. In our experience, the surgical preparation of a typical recipient takes about 1 h. This preparation is from first skin incision until all tissues are dissected, cleared, and with fixation sutures placed. In a live donor situation, the surgery of the recipient can start around 0.5 h before predicted vascular clamping with subsequent retrieval of the uterus. The recipient surgery will include sub-umbilical midline incision, dissection of the vaginal vault to free the top of the vagina from the bladder and the rectum, bilateral dissections to clear external iliac artery and vein, and bilateral placements of sutures for subsequent uterine fixation. In patients with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, there will be rudimentary uterine-like tissue above the vaginal vault and that tissue has to be cleaved to reach the top of the vagina. In patients with a present but nonfunctioning uterus or a cervical stump, total hysterectomy or cervical excision is included in the preparation procedure. A surgically well-prepared pelvic region of the recipient will increase the chance of a successful uterus transplantation procedure by facilitating short durations of warm ischemia and well-controlled surgery.