Multivisceral transplantation of pelvic organs in rats

Flavio Henrique Ferreira Galvao; Jun Araki; Ana Bruna Salles Fonseca; Ruy Jorge Cruz Jr; Cinthia Lanchotte; Daniel Reis Waisberg; Eleazar Chaib; Lucas Souto Nacif; Maria Clara de Camargo Traldi; Estrella Bianco de Mello; Wellington Andraus; Luiz Carneiro-D'Albuquerque

doi:10.3389/fsurg.2023.1086651

Multivisceral transplantation of pelvic organs in rats

Front Surg. 2023 Apr 20:10:1086651. doi: 10.3389/fsurg.2023.1086651. eCollection 2023.

Affiliations

¹ Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
² Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
³ Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.

Abstract

Background: Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats.

Donor operation: We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed en bloc, flushed, and cold-stored.

Recipient operation: The infrarenal aorta and vena cava were isolated and donor/recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery.

Results: We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation.

Conclusion: The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.

Keywords: anal canal; dysphoria; fecal incontinence; gender reassignment; intestinal transplantation; pelvic floor disorders; tissue transplantation; urinary incontinence.