Techniques for successful vaginal anastomosis in the uterine transplantation patient

Abstract

Objective: To demonstrate techniques for successful donor-to-recipient vaginal anastomosis in uterine transplantation including illustration of a tension-free technique.

Design: This video uses live-action footage from surgery, detailed animations, and illustrations to review the step-by-step technique we use for vaginal anastomosis in uterine transplantation. Institutional Review Board approval was obtained for this experimental surgery.

Setting: Academic medical center.

Patient(s): Patients undergoing uterine transplantation.

Intervention(s): Preparation of recipient vagina with illustration of challenges and risk secondary to dense adhesions between bladder and neo-vagina. Use of surgical techniques. Key steps include appropriate preparation of both donor and recipient vaginal tissues and a tension-free closure with horizontal mattress stitches.

Main outcome measure(s): Intraoperative techniques in the clinical research trial of uterine transplantation.

Results: Successful vaginal anastomosis in the uterine transplantation patient.

Conclusion(s): This video provides a step-by-step guide to vaginal anastomosis in uterine transplantation patients. Our team has applied techniques from vaginal reconstructive surgery in an attempt to reduce the occurrence of postoperative vaginal strictures, with attention to planned donor and recipient anastomosis site tissue preparation and closure of the anastomosis using a tension-free suturing technique.

Keywords: Absolute uterine factor infertility; Mayer-Rokitansky-Küster-Hauser; uterine transplantation.