Uterine Autotransplantation in the Nonhuman Primate With Preservation of the Uterine and Ovarian Vascular Pedicles
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Uterine Autotransplantation in the Nonhuman Primate With Preservation of the Uterine and Ovarian Vascular Pedicles
Reproductive Sciences 1-7 ª The Author(s) 2018 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1933719118765976 journals.sagepub.com/home/rsx
Michelle N. Han, MD1 , Hugo Ramirez, MD2, Luis Ruvalcaba, MD3, Juan Luis Contreras, MD4, Atunga Nyachieo, PhD5, and Edwin Ramirez, MD6
Abstract Purpose: To evaluate the technical feasibility of performing a uterine autotransplantation in the nonhuman primate while preserving the uterine and ovarian vascular pedicles. Methods: Eight (n ¼ 8) female baboons at a primate research facility underwent a uterine autotransplant procedure with preservation of the vascular pedicles. The uterine arteries were separated from their amorphous tissue and skeletonized toward the internal iliac arteries bilaterally. A segment of the internal iliac artery was removed bilaterally along with both uterine arteries. Both ovarian veins were preserved to assist with the reperfusion of the uterine organ. Due to larger vascular pedicles in one of the primates, the uterine arteries were separated and reattached directly via end-to-end anastomosis. In another baboon, the deep uterine vein was used as a vascular pedicle rather than the ovarian vein on the left side due to adequate size and visualization. Results: Immediate tissue reperfusion occurred intraoperatively in 5 of the animals, with slower perfusion in 3 of the animals. Average warm ischemia time was 43.8 minutes while the average cold ischemia time was 174 minutes (2 hours, 54 minutes). Average total surgical time was 5.9 hours. All animals were sheltered into separate cages and monitored for behavior changes and food and drink consumption. Three of the primates expired immediately postoperatively, 2 from severe dehydration and 1 from gastric aspiration. Conclusions: This pilot study describes a modified surgical approach for uterine transplants in the nonhuman primate. This surgical technique may be applicable to living and deceased donor uterine transplantation. Keywords baboon, tissue reperfusion, cold ischemia
Introduction Uterus transplantation (UTx) has arisen as a possible treatment of absolute uterine factor infertility, which affects between 3% and 5% of the general population.1 A number of studies focusing on UTx have been performed in animals and humans in the past decade, with great progress.1,2 However, along with progress in research, moral and ethical dilemmas associated with UTx have surfaced.1,3-5 Some of these issues stem from the fact that this procedure is not needed for preservation of life and that other options for uterine factor infertility such as adoption and surrogacy are available, without incurring the potential morbidity associated with UTx for the patient, fetus, and live donor.3 However, with research continuously evolving on the techniques of uterine transplantation, this may represent a safe alternative treatment for women affected by uterine factor infertility. Uterin
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