Evolution and Transformation of Uterine Transplantation: A Systematic Review of Surgical Techniques and Out… – Physician’s Weekly

Uterine transplantation (UTx) is acknowledged to be on the second (2A) of five steps of development in accordance with the staging system for the evaluation of surgical innovations. Accordingly, we aimed to systematically review the available evidence of the surgical techniques and outcomes of UTx in terms of graft survival.A comprehensive search was conducted across PubMed Medline, Cochrane-EBMR, Scopus, Web of Science, and CENTRAL through November 2020.Forty studies, reporting 64 recipients and 64 donors, satisfied inclusion criteria. The surgical time and the estimated blood loss were 515minutes and 679mL for graft procurement via laparotomy, 210minutes and 100mL for laparoscopic-assisted graft harvest, and 660minutes and 173mL for robotic-assisted procedures, respectively. Urinary tract infections (=8) and injury to the urinary system (=6) were the most common donor complications. Using the donors internal iliac system, two arterial anastomoses were performed in all cases. Venous outflow was accomplished through the uterine veins (UVs) in 13 cases, a combination of the UVs and the ovarian/uteroovarian veins (OVs/UOVs) in 36 cases, and solely through the OVs/UOVs in 13 cases. Ischemia time was 161 and 258minutes when using living donors (LD) and deceased donors (DD), respectively. Forty-eight uteri were successfully transplanted or fulfilled the purpose of transplantation, 41 from LDs and 7 from DDs. Twenty-five and four live childbirths from LDs and DDs have been reported, respectively.UTx is still experimental. Further series are required to recommend specific surgical techniques that best yield a successful transplant and reduce complications for donors and recipients.Thieme. All rights reserved.

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Evolution and Transformation of Uterine Transplantation: A Systematic Review of Surgical Techniques and Out... - Physician's Weekly