Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Fertil Steril. 2024 Jul;122(1):181-183. doi: 10.1016/j.fertnstert.2024.03.009. Epub 2024 Mar 24.
To report the first described case of robotic-assisted utero-ovarian transposition followed by anatomic repositioning in the pelvis and cervicovaginal anastomosis in a woman with uterine fibroids, which was performed for fertility preservation in the context of pelvic radiation for rectal cancer.
Description of technique and live-action narrated surgical footage showing uterine transposition and repositioning.
University hospital.
A 36-year-old woman with a new diagnosis of cT3N2M0 rectal adenocarcinoma planned for neoadjuvant chemotherapy and pelvic radiation and desired fertility preservation permissive of future pregnancy. A transvaginal ultrasound revealed a 5-cm posterior leiomyoma and a normal endometrial cavity. The patient elected for utero-ovarian transposition before chemoradiation. The patient included in this video gave consent for publication and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. Per institutional guidelines, an Institutional Review Board review was not required.
Robotic-assisted utero-ovarian transposition was performed in an inpatient setting 2 weeks after ovarian stimulation and oocyte retrieval. She was given a gonadotropin-releasing hormone agonist for menstrual suppression after oocyte retrieval. The uterus and adnexa were transposed en bloc to the upper abdomen, with perfusion via retroflected infundibulopelvic ligaments. Intravenous indocyanine green was administered intraoperatively to visualize uterine perfusion. Three weeks postoperatively, the patient underwent surgical management of small bowel obstruction, which was successfully managed with laparoscopic adhesiolysis. The patient subsequently completed chemoradiation and had a complete response to the rectal tumor. She therefore elected for surveillance. Seven months after transposition and 2 months after completion of treatment, the patient underwent uncomplicated robotic-assisted utero-ovarian anatomic repositioning in the pelvis with cervicovaginal anastomosis. Chromopertubation confirmed tubal patency.
Restoration of normal pelvic anatomy and resumption of reproductive physiology.
At her 4-month postoperative visit, the cervix and vagina were normal in appearance. The patient reported the return of spontaneous menses and sexual activity without complications.
This case is unique because of the presence of bulky intramural uterine fibroids. The described technique may be useful for selected cancer patients who desire to carry a pregnancy after pelvic radiation for cancer treatment, and demonstrates that patients considering utero-ovarian transposition need not be excluded solely on the basis of the presence of uterine fibroids.
报告首例机器人辅助子宫-卵巢转位术，随后在盆腔内进行解剖复位和宫颈阴道吻合术，该手术适用于因直肠癌盆腔放疗而保留生育能力的患者。
描述技术并展示手术过程中的实时动作，演示子宫转位和复位。
大学医院。
一名 36 岁女性，新诊断为 cT3N2M0 直肠腺癌，计划接受新辅助化疗和盆腔放疗，并希望在允许未来妊娠的情况下保留生育能力。经阴道超声显示后壁有一个 5cm 的子宫肌瘤，子宫内膜腔正常。患者选择在放化疗前进行子宫-卵巢转位。参与本视频的患者同意发表和在线发布视频，包括在社交媒体、杂志网站、科学文献网站和其他适用网站上发布。根据机构指南，不需要机构审查委员会审查。
在卵巢刺激和卵母细胞取出后 2 周，在住院环境下进行机器人辅助子宫-卵巢转位。卵母细胞取出后，患者给予促性腺激素释放激素激动剂抑制月经。子宫和附件整块转位到上腹部，通过逆行迂曲的卵巢悬韧带进行灌注。术中给予静脉吲哚菁绿以可视化子宫灌注。术后 3 周，患者因小肠梗阻接受手术治疗，腹腔镜粘连松解术成功治疗。患者随后完成放化疗，直肠肿瘤完全缓解，因此选择进行监测。转位后 7 个月和治疗完成后 2 个月，患者在盆腔内进行了简单的机器人辅助子宫-卵巢解剖复位和宫颈阴道吻合术。色标通液术证实输卵管通畅。
恢复正常盆腔解剖结构和恢复生殖生理功能。
术后 4 个月就诊时，宫颈和阴道外观正常。患者自述月经恢复正常，并能正常进行性生活，无并发症。
本病例的独特之处在于存在较大的子宫壁肌瘤。所描述的技术可能对因接受盆腔放疗治疗癌症而希望在癌症治疗后怀孕的特定癌症患者有用，并表明考虑进行子宫-卵巢转位的患者不应仅因存在子宫肌瘤而被排除在外。
