A child has been born following a uterus transplantation achieved solely by robot-assisted surgery on both donor and recipient by the research team at the University of Gothenburg.
The baby, a boy measuring 49 centimetres and weighing 6 pounds 13 ounces, was delivered by planned caesarean section on Thursday, May 25.
The child and the rest of the family are well, as is the donor. The new mother is 35 and the donor is a relative.
What distinguishes this case is the surgical method used in the transplantation itself.
The donor and recipient alike were operated on entirely by means of robot-assisted laparoscopic surgery with no open-surgery. The final step in the retrieval involved detaching the uterus from its blood vessels and removing it vaginally in a laparoscopic pouch. It was then possible to insert the uterus into the recipient’s pelvis through a small incision before undertaking a vascular anastomosis and subsequently suturing it to the vagina and supportive tissue. All these steps were robotically assisted.
The original transplantation was carried out at Sahlgrenska University Hospital in October 2021.
Ten months later, an embryo created by in vitro fertilization (IVF) before the transplantation was inserted in the transplanted uterus, and a few weeks later pregnancy was verified.
The mother-to-be felt well throughout her pregnancy, which concluded with a planned C-section in the 38th week.
Pernilla Dahm-Kähler, adjunct professor of obstetrics and gynaecology at Sahlgrenska Academy, University of Gothenburg, is also a gynaecologist and senior consultant doctor at Sahlgrenska University Hospital.
As the principal surgeon in the intricate operation on the recipient, she describes the technique.
She said: “With robot-assisted keyhole surgery, we can carry out ultra-fine precision surgery.
“The technique gives a very good access to operate deep down into the pelvis.
“This is the surgery of the future, and we’re proud and glad to have been able to develop uterine transplantations to this minimally invasive technical level.”
Niclas Kvarnström is the transplant surgeon in charge on the research project, and the one who performs the intricate vascular anastomosis in the recipient.
He said: “With the robot assisted technique procedures can be done that were previously considered impossible to perform with standard keyhole surgery.
“It is a privilege to be part of the evolution in this field with the overall goal to minimise the trauma to the patient caused by the surgery.”
The transplantation represents a further development of the uterus transplantation program that began with an open-surgery technique in Sweden in 2012.
The work is headed by Mats Brännström, Professor of Obstetrics and Gynaecology at Sahlgrenska Academy, University of Gothenburg, and Gynaecologist and senior consultant doctor at the University Hospital.
He said: “This is the 14th baby born in the uterus transplantation project at Sahlgrenska Academy, and more births are awaited this summer.
“The research project continuously evaluates numerous variables in donors, recipients, and children after the uterus transplantation, following up the operation for several years afterward.
“All this is done to maximise the efficacy of the operation and minimise side effects in the patients.”
In 2014, the research culminated in the world’s first birth after a uterus transplantation.
The research group has spread the methods and technique further through direct knowledge transfer to several centres around the world.
An estimated 90 uterus transplantations worldwide have been performed, and some 50 babies have been born as a result.
Picture credit: Björn Larsson Rosvall
