Achieving uterine auto‐transplantation in a sheep model using iliac vessel anastomosis: a short‐term viability study. (25th December 2014)

• Record Type: Journal Article
• Authors: Saso, Srdjan; Petts, Gemma; Thum, Meen‐Yau; Corless, David; Boyd, Michael; Noakes, David; Del Priore, Giuseppe; Ghaem‐Maghami, Sadaf; Smith, James Richard
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 94:Number 3(2015)
• Page Start: 245
• Page End: 252
• Publication Date: 2014-12-25
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12550
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12550-abs-0001"> <title>Abstract</title> <sec id="aogs12550-sec-0001" sec-type="section"> <title>Objective</title> <p>To investigate, develop and evaluate anatomical, surgical and anastomotic aspects necessary for a successful uterine transplant in a large‐animal model.</p> </sec> <sec id="aogs12550-sec-0002" sec-type="section"> <title>Design</title> <p>Sheep model; longitudinal study involving five ewes.</p> </sec> <sec id="aogs12550-sec-0003" sec-type="section"> <title>Setting</title> <p>Royal Veterinary College, London, UK.</p> </sec> <sec id="aogs12550-sec-0004" sec-type="section"> <title>Population</title> <p>Five ewes of proven fertility.</p> </sec> <sec id="aogs12550-sec-0005" sec-type="section"> <title>Methods</title> <p>The uterine allograft along with the internal iliacs, and uterine arterial and venous tree all intact were harvested en bloc. An end‐to‐side anastomosis was performed between the external iliac vessels and the internal iliac vessels of the graft using 6‐0 polypropylene. Successful reperfusion of the graft was initially judged by the color shift of the uterus during reperfusion. Blood flow past the venous and arterial anastomotic sites was also ensured by visual inspection, together with pulse oximetry and multispectral imaging.</p> </sec> <sec id="aogs12550-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Operative details (retrieval, ischemic, clamping, reperfusion and recipient hysterectomy duration); physiological profiles; gross morphology and histopathology.</p> </sec> <sec id="aogs12550-sec-0007" sec-type="section"> <title>Results</title> <p>Five autotransplants were performed. One procedure was abandoned because of the inappropriate size of sheep model. Another procedure was halted because the animal suffered from respiratory failure in the immediate intra‐operative period. Three transplants were completed. In those, at least two of four possible anastomoses were finished and the grafted uteri demonstrated immediate perfusion and appropriate viability 45 min post‐operatively.</p> </sec> <sec id="aogs12550-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Internal to external iliac vessel anastomoses are an acceptable surgical technique that should be applied in a human model to ensure adequate subsequent uterine perfusion.</p> </sec> </abstract>