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World’s first childbirth following a uterus transplantation achieved by robot-assisted surgery

In a groundbreaking achievement by the renowned research team at the University of Gothenburg, a child has been born for the first time ever through a uterus transplantation carried out exclusively using robot-assisted surgery on both the donor and recipient.

The baby, a boy measuring 49 centimeters (19.3 inches) and weighing 3,100 grams (6 pounds 13 ounces), was delivered by planned cesarean section on Thursday, May 25. The child, along with the entire family, is in good health, and the donor is also doing well. The recipient, a 35-year-old woman, and the donor are related.

What sets this case apart is the surgical technique employed during the transplantation. In this instance, both the donor and recipient underwent robot-assisted laparoscopic (keyhole) surgery, commonly referred to as "robot surgery," without the need for open surgery.

Compared to traditional open surgery, robot surgery is significantly less invasive. It has been observed that the risks of complications such as infections and hemorrhages are lower when robot surgery is employed in various procedures. Patients who undergo this method typically experience a faster recovery.

The procedure involves inserting cameras and robotic arms equipped with surgical instruments through small incisions in the lower abdomen. Surgeons control the robotic arms using tools similar to joysticks at consoles, allowing them to view dynamic 3D images and perform precise operations simultaneously.

Minimally invasive, highly precise

In the specific instance at Sahlgrenska University Hospital in October 2021, the transplantation procedure unfolded. Robot surgery played a crucial role in meticulously freeing the donor's uterus step by step. The final stage involved detaching the uterus from its blood vessels and extracting it through the vagina using a laparoscopic pouch.

Subsequently, in the recipient, the uterus could be introduced into the pelvic region through a small incision. First, it was sutured to the blood vessels, followed by suturing to the vagina and supportive tissue. Throughout these stages, robot surgery provided valuable assistance.

After ten months, an embryo created through in vitro fertilization (IVF) prior to the transplantation was implanted in the transplanted uterus. A few weeks later, the pregnancy was confirmed. The expectant mother experienced well-being throughout her pregnancy, which culminated in a planned C-section in the 38th week.

Pernilla Dahm-Kähler, who holds the position of adjunct professor of obstetrics and gynecology at Sahlgrenska Academy, University of Gothenburg, as well as being a gynecologist and senior consultant doctor at Sahlgrenska University Hospital, served as the principal surgeon in the intricate operation performed on the recipient. She provides insights into the technique used.

''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."

Previously considered impossible

Taking the lead in the research project is Niclas Kvarnström, the transplant surgeon responsible for performing the intricate blood-vessel suturing in the recipient. He highlights the significance of the robot-assisted technique, stating that it enables procedures that were previously deemed impossible with standard keyhole surgery. He considers it a privilege to be part of the evolutionary advancements in this field, aiming to minimize surgical trauma experienced by patients.

The uterus transplantation procedure has progressed further from its initial implementation as an open-surgery technique in Sweden in 2012. The project is spearheaded by Mats Brännström, a professor of obstetrics and gynecology at Sahlgrenska Academy, University of Gothenburg, and a gynecologist and senior consultant doctor at the University Hospital.

"This birth marks the 14th baby born within the uterus transplantation project at Sahlgrenska Academy, and we anticipate more births this summer. The research project continually assesses numerous factors in donors, recipients, and children following the transplantation, conducting follow-ups for several years post-surgery. These efforts aim to maximize the effectiveness of the operation while minimizing any adverse effects on the patients," explains Brännström.

In 2014, the culmination of the research led to the world's first successful birth following a uterus transplantation. Within the same research project, a total of eight births occurred before any baby was delivered through a receiving uterus transplant outside of Sweden.

The research group has actively disseminated their methods and techniques, facilitating direct knowledge transfer to various centers worldwide. As a result, approximately 90 uterus transplantations have been performed globally, leading to the birth of around 50 babies.

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