Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
STOCKHOLM IVF-EUGIN, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1222-1229. doi: 10.1111/aogs.13853. Epub 2020 Apr 12.
The proof-of-concept of uterus transplantation, as a treatment for absolute uterine factor infertility, came with the first live birth after uterus transplantation, which took place in Sweden in 2014. This was after a live donor procedure, with laparotomy in both donor and recipient. In our second, ongoing trial we introduced a robotic-assisted laparoscopic surgery of the donor to develop minimal invasive surgery for this procedure. Here, we report the surgery and pregnancy behind the first live birth from that trial.
In the present study, within a prospective observational study, a 62-year-old mother was the uterus donor and her 33-year-old daughter with uterine absence as part of the Mayer-Rokitansky-Küster-Hauser syndrome, was the recipient. Donor surgery was mainly done by robotic-assisted laparoscopy, involving dissections of the utero-vaginal fossa, arteries and ureters. The last part of surgery was by laparotomy. Recipient laparotomy included vascular anastomoses to the external iliac vessels. Data relating to in vitro fertilization, surgery, follow up, obstetrics and postnatal growth are presented.
Three in vitro fertilization cycles prior to transplantation gave 12 cryopreserved embryos. The surgical time of the donor in the robot was 360 minutes, according to protocol. The durations for robotic surgery for dissections of the utero-vaginal fossa, arteries and ureters were 30, 160 and 84 minutes, respectively. The remainder of donor surgery was by laparotomy. Recipient surgery included preparations of the vaginal vault, three end-to-side anastomoses (one arterial, two venous) on each side to the external iliacs and fixation of the uterus. Ten months after transplantation, one blastocyst was transferred and resulted in pregnancy, which proceeded uneventfully until elective cesarean section in week 36 . A healthy boy (Apgar 9-10-10) was delivered. Follow up of child has been uneventful for 12 months.
This is the first report of a live birth after use of robotic-assisted laparoscopy in uterus transplantation and is thereby a proof-of-concept of use of minimal invasive surgery in this new type of transplantation.
作为治疗绝对子宫因素不孕的一种方法，子宫移植的概念验证随着 2014 年瑞典首例子宫移植后活产而实现。这是在活体供者程序之后，供者和受者都进行了剖腹手术。在我们的第二项正在进行的试验中，我们引入了机器人辅助腹腔镜手术供者，以开发这种手术的微创技术。在这里，我们报告了首例来自该试验的活产背后的手术和妊娠情况。
在本研究中，在一项前瞻性观察研究中，一名 62 岁的母亲是子宫供者，她 33 岁的女儿患有子宫缺失，作为梅耶-罗基坦斯基-库斯特-豪泽综合征的一部分，是受者。供者手术主要通过机器人辅助腹腔镜进行，包括阴道穹窿、动脉和输尿管的解剖。手术的最后一部分是剖腹手术。受者剖腹手术包括将血管吻合到髂外血管。介绍了与体外受精、手术、随访、产科和产后生长相关的数据。
移植前进行了三次体外受精周期，获得了 12 个冷冻胚胎。根据方案，供者在机器人中的手术时间为 360 分钟。机器人阴道穹窿、动脉和输尿管解剖的手术时间分别为 30、160 和 84 分钟。供者手术的其余部分是剖腹手术。受者手术包括阴道穹窿的准备、两侧各三个端侧吻合（一个动脉，两个静脉）到髂外血管和子宫的固定。移植后 10 个月，转移了一个胚泡，导致妊娠，妊娠顺利进行，直到第 36 周选择性剖宫产。一名健康男孩（阿普加 9-10-10）出生。对孩子的随访 12 个月以来一直没有异常。
这是首例使用机器人辅助腹腔镜手术进行子宫移植后活产的报告，因此证明了微创技术在这种新型移植中的应用。
