Results
This review included 26 original articles (Fig. 2). Reports of
living-donor uterus transplants from Saudi Arabia,3Sweden,4,6,11-19 China,10,20 USA
(Dallas),8,21-24 Czech
Republic,7,25,26 Germany,27,28 and
India9,29 were identified, and 51 living-donor UTx
were incorporated. The surgical information and clinical data for each
case are shown in Table 1. In one case in Germany, the uterus was
removed from a donor, but was found to be unsuitable for transplantation
during back table processing, and the transplant was not performed. In
another case, the uterine veins were not used for transplantation, even
though they were preserved and removed from the donor in Czech case.
Of the 51 living-donor UTx cases, the open approach was used in 33
cases, the laparoscopic approach in four cases, and the robot-assisted
approach in 14 cases. The data of each approach are summarised in Table
2. The average operative time was 8 hours 26 minutes ± 2 hours 47
minutes for the open approach, 3 hours 30 minutes ± 0 hour 33 minutes
for the laparoscopic approach, and 10 hours 59 minutes ± 1 hours 45
minutes for the robot-assisted approach, with a trend toward shorter
operative times for the laparoscopic approach and longer operative times
for the robot-assisted approach. The mean blood loss was 715 ± 584 mL
with the open approach, 100 ± 0 ml with the laparoscopic approach, and
209 ± 182 mL with the robot-assisted approach, with a trend toward less
blood loss with minimally invasive procedures, such as the laparoscopic
and robot-assisted approaches. The day of discharge was 6.2 ± 1.3
postoperative days on average with the open approach, 6.5 ± 0.5 days
postoperatively with the laparoscopic approach, and 4.3 ± 1.0 days
postoperatively with the robot-assisted approach. There were 19 surgical
complications with the open approach (57.6%), zero with the
laparoscopic approach (0.0%), and six with the robot-assisted approach
(42.9%). There were nine cases (28.1%) of graft failure in open
approach, zero cases (0.0%) on the laparoscopic approach, and two cases
(14.3%) in the robot-assisted approach. Live birth after living-donor
UTx was reported in 16 cases (48.5%) with the open approach, zero cases
(0.0%) with the laparoscopic approach, and two cases (14.3%) with the
robot-assisted approach.
Clinical data for each operative approach with or without the uterine
veins are also shown in Table 2. In the open approach, the mean
operative time was 8 hours 45 minutes ± 2 hours 39 minutes and the mean
blood loss was 711 ± 586 ml in the cases where UVs were preserved (n =
29); and in the cases where UVs were not preserved (n = 4), the mean
operative time was 6 hours 14 minutes ± 0 hours 26 minutes, and the mean
blood loss was 738 ± 569 mL. In the laparoscopic approach, the mean
operative time was 4 hours 0 minutes ± 0 hours 0 minutes and the mean
blood loss was 100 ± 0 mL in the UVs preserved cases (n = 2), and the
mean operative time was 3 hours 0 minutes ± 0 hours 20 minutes and the
mean blood loss was 100 ± 0 ml in the non-UVs preserved cases (n = 2).
In the robot-assisted approach, the mean operative time and mean blood
loss were 11 hours 19 minutes ± 1 hour 8 minutes and 245 ± 197 mL in the
UVs preserved cases (n = 12), respectively, and the mean operative time
was 9 hours 1 minute ± 3 hours 1 minute and the mean blood loss was 100
± 0 mL in the non-UVs preserved cases (n = 2). In each approach, the
operative time was reduced in the non-UVs preserved cases. The discharge
time was 6.3 ± 1.4 postoperative days for the open approach in the UVs
preserved cases, and 5.8 ± 0.8 days in the non-UVs preserved cases; 7.0
± 0.0 postoperative days for the laparoscopic approach in the UVs
preserved cases, 6.0 ± 0.0 postoperative days in the non-UVs preserved
cases. In the robot-assisted approach, the postoperative discharge time
was 4.4 ± 1.0 days in the UVs preserved cases and 4.0 ± 0.0 days in the
non-UVs preserved cases. There was little difference between patients
with and without UVs preserved. Operative complications were found in 17
(58.6%) cases for the open approach with UVs preserved, and in two
(50.0%) cases for non-UVs preserved. No complications were reported
with the laparoscopic approach in both of the UVs preserved and non-UVs
preserved cases. Complications tended to occur more frequently in the
robot-assisted approach, with six cases (50.0%) observed solely in the
UVs preserved cases, with none in the non-UVs preserved cases.
Complications were more frequent in the UVs preserved cases. In the
robot-assisted approach, graft failure was reported in two patients
(16.7%) with UVs preserved. Live births after UTx utilising the
laparoscopic approach were not reported in any of the papers included in
this review. In the robot-assisted approach, one case (8.3%) of a live
birth was reported from the UVs preserved cases, and one (50.0%) from
the non-UVs preserved cases.