Assessment of viability of assisted laparoscopic-robotic hysterectomy for uterine transplantation in the donor patient: description of donor and recipient surgical technique in inter-patient patients

Abstract

Currently, patients who do not have a uterus or who have a dysfunctional uterus face great difficulties when they have a reproductive desire. Transplantation of the uterus (3) appears as a revolutionary form of treatment for uterine factor infertility. In the United States, it is the only treatment option that would allow these patients to experience the gestation period and have their children. (1) There are about 100,000 hysterectomies annually in Brazil. (2) There are 2 ways of performing the withdrawal of the uterus in the donor patient. The first, described since 2014 is the conventional laparotomic technique. However, the studies describe long-term surgeries ranging from 10.5 to 13 hours, which directly affect the final surgical result. (4) And, a second alternative is through the minimally invasive, laparoscopic or assisted laparoscopic-robotic technique that is related to shorter surgical time and less intraoperative bleeding (5). The feasibility of the minimally invasive pathway was described in 2017 by Puntambekar S et al. (Cols). Described in 2016, the assisted laparoscopic-robotic route has so far described 14 cases of successful uterine transplant attempts. (6, 7). It was described that oncological surgeons had performed at least 60 radical hysterectomies and pelvic lymphadenectomies previously, this factor, which directly influenced the final surgical outcome. (6) Our goal in this project is to perform uterine transplant surgery at Barretos Cancer Hospital, to describe our surgical technique and to replicate the technique previously described in other world centers. We believe that this procedure will follow the evolution that has been performed so far in uterine transplant surgery and maintains Brazil as one of the pioneer countries in the world to perform this procedure. (AU)