Oktay Kutluk, Taylan Enes, Sugishita Yodo, Goldberg Gabriela M
Innovation Institute for Fertility and In Vitro Fertilization, New York, New York.
Innovation Institute for Fertility and In Vitro Fertilization, New York, New York.
J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):897-898. doi: 10.1016/j.jmig.2017.02.021. Epub 2017 Mar 6.
To show a new approach for orthotopic human ovarian tissue transplantation via robot-assisted laparoscopic surgery.
A step-by-step video explanation of the surgical technique (Canadian Task Force classification III).
Academic medical center.
The robot-assisted transplantation approach consisted of 3 steps: (1) reconstruction of the ovarian tissue graft, (2) preparation of the contralateral menopausal ovary as the recipient site, and 3) transplantation of the reconstructed graft to the bivalved contralateral ovary. Institutional review board approval was obtained.
Although still experimental, cryopreservation and subsequent transplantation of frozen-thawed ovarian tissue are currently the only available methods for prepubertal girls and young women with cancer who are not eligible for established fertility preservation options such as oocyte or embryo cryopreservation [1]. We performed the first reported autologous ovarian transplantation with a conventional laparoscopic technique [2]. To date, over 60 babies have been born after the orthotopic transplantation of cryopreserved ovarian tissue, and this number is growing [3,4]. Until recently, all of these children were born from ovarian transplants that were performed via laparotomy or conventional laparoscopy [5]. We have recently developed a robot-assisted ovarian transplantation procedure that uses an extracellular matrix scaffold to facilitate ovarian reconstruction, handling, and revascularization. Both of the procedures resulted in robust ovarian function and births [6]. The purpose of this video reports the surgical technique in detail, which uses the da Vinci Xi (Intuitive Surgical Inc, Sunnyvale, CA) robotic system for transplantation, and a decellularized human extracellular tissue matrix (Alloderm; LifeCell Corp, Branchburg, NJ) for graft reconstruction.
Robotic ovarian transplantation may have several advantages, which include precision, more delicate graft handling, and reduced time from tissue thawing to transplantation. The collective usefulness of the extracellular tissue matrix may enhance this technique by enabling a niche for ovarian reconstruction and potentially enhanced revascularization. The feasibility and comparative advantages of this technique are currently being studied in ongoing trials.
展示一种通过机器人辅助腹腔镜手术进行原位人卵巢组织移植的新方法。
手术技术的分步视频讲解（加拿大工作组分类III级）。
学术医疗中心。
机器人辅助移植方法包括3个步骤：（1）卵巢组织移植物的重建；（2）将对侧绝经后卵巢作为受体部位进行准备；（3）将重建后的移植物移植到对侧二分卵巢。获得了机构审查委员会的批准。
尽管仍处于实验阶段，但冻融卵巢组织的冷冻保存及后续移植目前是青春期前女孩和患有癌症且不符合卵母细胞或胚胎冷冻保存等既定生育力保存选项条件的年轻女性的唯一可用方法[1]。我们使用传统腹腔镜技术进行了首例自体卵巢移植报道[2]。迄今为止，冷冻保存的卵巢组织原位移植后已有60多个婴儿出生，且这一数字还在增加[3,4]。直到最近，所有这些孩子均来自通过剖腹手术或传统腹腔镜手术进行的卵巢移植[5]。我们最近开发了一种机器人辅助卵巢移植程序，该程序使用细胞外基质支架来促进卵巢重建、操作和血管再生。这两种程序均产生了强大的卵巢功能并实现了生育[6]。本视频的目的是详细报道手术技术，该技术使用达芬奇Xi（直观外科公司，加利福尼亚州桑尼维尔）机器人系统进行移植，并使用脱细胞人细胞外组织基质（同种异体真皮；生命细胞公司，新泽西州布兰奇堡）进行移植物重建。
机器人辅助卵巢移植可能具有多种优势，包括精确性、更精细的移植物操作以及从组织解冻到移植所需时间的减少。细胞外组织基质的综合效用可能通过为卵巢重建创造微环境并潜在地增强血管再生来提升该技术。目前正在进行的试验中研究该技术的可行性和比较优势。
