Uterus transplantation: robotic surgeon perspective

Uterus transplantation: robotic surgeon perspective VIDEOS Uterus transplantation: robotic surgeon perspective Hubert Fornalik, M.D. and Nicole Fornalik, P.A.-C. Goshen Center for Cancer Care, Goshen, Indiana Objective: To study the safety and feasibility of robotic dissection of deep pelvic vessels as applied to the robotic harvesting of a uterus from live transplant donor. Design: Surgical video. Setting: Gynecologic oncology practice of a tertiary community cancer center. Patient(s): Two patients undergoing robotic nerve-sparing radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 cervical cancer. Intervention(s): Application of robotic platform to precise dissection of internal iliac artery and vein, their branches, including the su- perficial and deep uterine artery and vein. The robotic technique for deep pelvic dissection in gynecologic oncology demonstrated here provides superior outcomes compared with the open technique. In our settings, a typical robotic nerve-sparing radical hysterectomy takes 3 hours from completion of the pelvic lymphadenectomy to the moment when the patient leaves the operating room. Main Outcome Measure(s): Safety and adequacy of robotic dissection of deep pelvic vessels. The procedure's modification to the cur- rent technique demonstrated improved transplant blood supply and outflow. Demonstration of modification to current technique, that has potential to improve transplant blood supply and outflow. Result(s): Using the robotic technique for nerve-sparing radical hysterectomy, the pelvic vessels can be dissected with superior precision, hemostasis, efficiency, and clinical outcomes. Due to its difficulty, nerve-sparing radical hysterectomy is not even performed via a laparotomy approach in the United States. Robotic dissection allows for better exposure of the pelvic vessels, which may allow for harvesting intact uterine vessels with internal iliac artery and vein patches, thus facilitating wider vascular anastomosis and superior blood supply and outflow of the transplant. Conclusion(s): Uterine harvesting from a live donor is currently being performed via a laparotomy technique, resulting in long pro- cedures associated with significant morbidity. Based on our gynecologic oncology experience, a robotic approach to deep pelvic dissec- tion is superior to laparotomy. Robotic nerve-sparing radical hysterectomy is a difficult procedure that requires knowledge of deep pelvic vessels' anatomy, precise dissection techniques, and repetition. Robotic harvesting of the uterus for transplantation from a live donor may provide better results in terms of transplant survival and donor outcomes. This type of procedure should be attempted by a robotic team that has experience in working with deep and large pelvic vessels. (Fertil Steril 2018;109:365. 2017 by American Society for Reproductive Medicine.) Use your smartphone to scan this QR code Key Words: Internal iliac patch, nerve sparing radical hysterectomy, robotic deep pelvic and connect to the dissection, robotic uterus harvesting, uterus transplantation video for this article now.* Discuss: You can discuss this article with its authors and other readers at https://www. fertstertdialog.com/users/16110-fertility-and-sterility/posts/21354-24449 * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. vations and lessons learned from early setbacks 5. Shazly SA, Murad MH, Dowdy SC, Gostout BS, AVAILABLE ON YOUTUBE to technical success. Am J Tranplant 2017;17: Famuyide AO. Robotic radical hysterectomy in https://youtu.be/vlkS4z0l0HY 2901–10. early stage cervical cancer: a systematic review 3. Fujii S, Takakura K, Matsumura N, Higuchi T, and meta-analysis. Gynecol Oncol 2015;138: Yura S, Mandai M, et al. Precise anatomy of 457–71. SUGGESTED READING the vesico-uterine ligament for radical hysterec- 6. Fornalik H, Brooks H, Moore ES, Flanders N, € € 1. Brannstrom M. Uterus transplantation and tomy. Gynecol Oncol 2007;104:186–91. Callahan MJ, Sutton GP. Hand-assisted robotic beyond. J Mater Sci Mater Med 2017;28:70. 4. Magrina JF, Kho R, Magtibay PM. Robotic surgery for staging of ovarian cancer and uter- 2. Testa G, Koon EC, Johannesson L, McKenna GJ, radical hysterectomy: technical aspects. Gynecol ine cancers with high risk of peritoneal spread. Anthony T, Klintmalm GB, et al. Living donor Oncol 2009;113:28–31. Int J Gynecol Cancer 2015;25:1488–93. uterus transplantation: a single center’s obser- Received June 2, 2017; accepted October 31, 2017; published online December 13, 2017. H.F. has nothing to disclose. N.F. has nothing to disclose. Reprint requests: Hubert Fornalik, M.D., Goshen Center for Cancer Care, 200 High Park Avenue, Goshen, Indiana 46527 (E-mail: hubert.fornalik@gmail.com). Fertility and Sterility® Vol. 109, No. 2, February 2018 0015-0282/$36.00 Copyright ©2017 American Society for Reproductive Medicine, Published by Elsevier Inc. https://doi.org/10.1016/j.fertnstert.2017.10.038 VOL. 109 NO. 2 / FEBRUARY 2018 365 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Fertility and Sterility Elsevier

Uterus transplantation: robotic surgeon perspective

Free
1 page

Loading next page...
1 Page
 
/lp/elsevier/uterus-transplantation-robotic-surgeon-perspective-LDKth0l81L
Publisher
Elsevier
Copyright
Copyright © 2017 American Society for Reproductive Medicine
ISSN
0015-0282
D.O.I.
10.1016/j.fertnstert.2017.10.038
Publisher site
See Article on Publisher Site

Abstract

VIDEOS Uterus transplantation: robotic surgeon perspective Hubert Fornalik, M.D. and Nicole Fornalik, P.A.-C. Goshen Center for Cancer Care, Goshen, Indiana Objective: To study the safety and feasibility of robotic dissection of deep pelvic vessels as applied to the robotic harvesting of a uterus from live transplant donor. Design: Surgical video. Setting: Gynecologic oncology practice of a tertiary community cancer center. Patient(s): Two patients undergoing robotic nerve-sparing radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 cervical cancer. Intervention(s): Application of robotic platform to precise dissection of internal iliac artery and vein, their branches, including the su- perficial and deep uterine artery and vein. The robotic technique for deep pelvic dissection in gynecologic oncology demonstrated here provides superior outcomes compared with the open technique. In our settings, a typical robotic nerve-sparing radical hysterectomy takes 3 hours from completion of the pelvic lymphadenectomy to the moment when the patient leaves the operating room. Main Outcome Measure(s): Safety and adequacy of robotic dissection of deep pelvic vessels. The procedure's modification to the cur- rent technique demonstrated improved transplant blood supply and outflow. Demonstration of modification to current technique, that has potential to improve transplant blood supply and outflow. Result(s): Using the robotic technique for nerve-sparing radical hysterectomy, the pelvic vessels can be dissected with superior precision, hemostasis, efficiency, and clinical outcomes. Due to its difficulty, nerve-sparing radical hysterectomy is not even performed via a laparotomy approach in the United States. Robotic dissection allows for better exposure of the pelvic vessels, which may allow for harvesting intact uterine vessels with internal iliac artery and vein patches, thus facilitating wider vascular anastomosis and superior blood supply and outflow of the transplant. Conclusion(s): Uterine harvesting from a live donor is currently being performed via a laparotomy technique, resulting in long pro- cedures associated with significant morbidity. Based on our gynecologic oncology experience, a robotic approach to deep pelvic dissec- tion is superior to laparotomy. Robotic nerve-sparing radical hysterectomy is a difficult procedure that requires knowledge of deep pelvic vessels' anatomy, precise dissection techniques, and repetition. Robotic harvesting of the uterus for transplantation from a live donor may provide better results in terms of transplant survival and donor outcomes. This type of procedure should be attempted by a robotic team that has experience in working with deep and large pelvic vessels. (Fertil Steril 2018;109:365. 2017 by American Society for Reproductive Medicine.) Use your smartphone to scan this QR code Key Words: Internal iliac patch, nerve sparing radical hysterectomy, robotic deep pelvic and connect to the dissection, robotic uterus harvesting, uterus transplantation video for this article now.* Discuss: You can discuss this article with its authors and other readers at https://www. fertstertdialog.com/users/16110-fertility-and-sterility/posts/21354-24449 * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. vations and lessons learned from early setbacks 5. Shazly SA, Murad MH, Dowdy SC, Gostout BS, AVAILABLE ON YOUTUBE to technical success. Am J Tranplant 2017;17: Famuyide AO. Robotic radical hysterectomy in https://youtu.be/vlkS4z0l0HY 2901–10. early stage cervical cancer: a systematic review 3. Fujii S, Takakura K, Matsumura N, Higuchi T, and meta-analysis. Gynecol Oncol 2015;138: Yura S, Mandai M, et al. Precise anatomy of 457–71. SUGGESTED READING the vesico-uterine ligament for radical hysterec- 6. Fornalik H, Brooks H, Moore ES, Flanders N, € € 1. Brannstrom M. Uterus transplantation and tomy. Gynecol Oncol 2007;104:186–91. Callahan MJ, Sutton GP. Hand-assisted robotic beyond. J Mater Sci Mater Med 2017;28:70. 4. Magrina JF, Kho R, Magtibay PM. Robotic surgery for staging of ovarian cancer and uter- 2. Testa G, Koon EC, Johannesson L, McKenna GJ, radical hysterectomy: technical aspects. Gynecol ine cancers with high risk of peritoneal spread. Anthony T, Klintmalm GB, et al. Living donor Oncol 2009;113:28–31. Int J Gynecol Cancer 2015;25:1488–93. uterus transplantation: a single center’s obser- Received June 2, 2017; accepted October 31, 2017; published online December 13, 2017. H.F. has nothing to disclose. N.F. has nothing to disclose. Reprint requests: Hubert Fornalik, M.D., Goshen Center for Cancer Care, 200 High Park Avenue, Goshen, Indiana 46527 (E-mail: hubert.fornalik@gmail.com). Fertility and Sterility® Vol. 109, No. 2, February 2018 0015-0282/$36.00 Copyright ©2017 American Society for Reproductive Medicine, Published by Elsevier Inc. https://doi.org/10.1016/j.fertnstert.2017.10.038 VOL. 109 NO. 2 / FEBRUARY 2018 365

Journal

Fertility and SterilityElsevier

Published: Feb 1, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve Freelancer

DeepDyve Pro

Price
FREE
$49/month

$360/year
Save searches from
Google Scholar,
PubMed
Create lists to
organize your research
Export lists, citations
Read DeepDyve articles
Abstract access only
Unlimited access to over
18 million full-text articles
Print
20 pages/month
PDF Discount
20% off