2023-06-19 03:10:30
For the first time, a child has been born after a uterus transplant that was performed entirely robotically. Will the process soon become established worldwide?
The baby, a boy measuring 49 centimeters and weighing 3,100 grams, was delivered by planned cesarean section. The child and family are doing well, as is the donor. The new mother is 35 years old and the donor is a relative.
Gentle surgery by robots
What is special about this case is the surgical method used in the transplantation itself. In this case, the donor and recipient were operated exclusively using robot-assisted laparoscopic (keyhole) surgery – robotic surgery for short – without an open surgical procedure. It’s a breakthrough by the research team at Gothenburg University.
Robotic surgery is significantly less invasive than traditional open surgery. Other surgeries have shown that the risk of infection and bleeding is reduced when robotic surgery is used. The operated patients are generally faster on their feet again. The method involves inserting cameras and robotic arms with attached surgical instruments through small entry holes in the lower abdomen. The surgeons then control the robotic arms with joystick-like tools at consoles, where they can simultaneously see moving 3D images and operate with great precision.
From fertilization to birth
In the present case, the transplant was performed in October 2021 at Sahlgrenska University Hospital. The donor’s uterus was removed with the help of a robot. In the last step, the uterus was detached from its blood vessels and removed vaginally in a laparoscopic bag. In the recipient, the uterus could then be inserted through a small incision in the woman’s pelvis, sutured first to the blood vessels, and then to the vagina and supporting tissues. All these steps were assisted by a robot.
Ten months later, a pre-transplant embryo created by in vitro fertilization (IVF) was placed in the transplanted uterus, and a few weeks later, pregnancy was confirmed. The mother-to-be felt comfortable throughout her pregnancy. She ended up having a planned cesarean section at 38 weeks.
The surgery of the future
Pernilla Dahm-Kähler, Professor of Obstetrics and Gynecology at Sahlgrenska Academy, University of Gothenburg, is Senior Consultant at Sahlgrenska University Hospital. As the senior surgeon for the complicated operation on the recipient, she describes the technique as follows: “With robot-assisted keyhole surgery, we can perform an ultra-fine precision operation. The technique offers very good access to operate deep into the pelvis. This is the surgery of the future and we are proud and happy that we were able to bring uterine transplantation to this minimally invasive level of technology,” she says.
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Niclas Kvarnström is the transplant surgeon in charge of the research project, who performed the intricate stitching on the recipient’s blood vessels. “The robot-assisted technology makes it possible to perform procedures that were previously considered impossible using conventional keyhole surgery. It’s a privilege to be part of the development in this area, with the overarching goal of minimizing the patient’s discomfort from the procedure,” he says.
Sweden as a precursor
This form of transplantation represents a further development of the uterus transplantation, which was started in Sweden in 2012 with an open surgical technique. The work is led by Mats Brännström, senior consultant at the University Hospital in Gothenburg. “This is the 14th baby born as part of the uterine transplant project at Sahlgrenska Academy and more births are expected this summer. As part of the research project, numerous variables in donors, recipients and children after uterine transplantation are continuously evaluated and the operation is followed up for several years. All of this is done to maximize the effectiveness of the surgery and minimize the side effects for the patients,” says Brännström.
In 2014, research culminated in the world’s first birth after a uterus transplant. A total of eight births took place as part of the same research project before anyone outside of Sweden gave birth to a baby after a uterus transplant. The research group has disseminated the methods and the technique through direct knowledge transfer to several centers around the world. An estimated 90 uterine transplants have been performed worldwide and about 50 babies have been born as a result.
The post is based on a press release of the Swedish Research Council.
Image source: Jonathan Borba, unsplash
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