Page 22 - Plasticos-Vol-3
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THE GIFT OF WOMB : CHANGING LIVES BY CREATING LIVES
ROLE OF A PLASTIC SURGEON IN UTERINE TRANSPLANT
Dr Giriraj Gandhi, Dr Nikhil Agarkhedkar, Dr Shailesh Puntambekar
counsellor and transplant coordinator . After
multiple meetings, and going through all the
limited literature, a protocol for the pre-op
management, intraoperative steps and post-
op management was fixed for the cases.
Patient Selection
Two uterine transplants back to back were
planned on 18th and 19th May 2017. The
Dr Giriraj Gandhi Dr Nikhil Agarkhedkar selection of candidates for the procedure
was done by modified Montreal Criteria as
Uterine transplant guidelines. The first patient was a case of MRKH
syndrome with congenital absence of uterus.
When you first hear these words, many The second case was a patient of Asherman
questions flood the mind; WHAT? WHEN? Syndrome causing secondary infertility. The
HOW? WHY? And so on. This article is aimed donors in both the cases were the mothers
at addressing these questions and hopefully of the patients. The options of surrogacy and
clearing doubts. adoption were explained to the patients. The
The first time I heard about uterine transplant, experimental nature of the surgery and the
was in September 2016 when I was in the United possible complications including rejection of
States for a fellowship. A uterine transplant the uterine graft due to immunologic reasons
had been performed, the earlier day, in Baylor were informed to the patient.
University Medical Center, Dallas. Everyone was
excitedly discussing the incredible surgery and Preparation for the
the medical marvel it would turn out to be,
when the lady gives birth to a healthy child!! The Surgery (Micro-surgical Team)
thought was overwhelming and seemingly
impossible to me . Little did I know at that Preparation for the transplant started well
time that I would be a part of the historic team in advance. Cadaveric dissections were
that performed the surgery for the first time in performed before we started doing the
India. vascular dissection of the specimen of the
A team led by Dr Shailesh Puntambekar was uterus removed in cases of cervical cancer. This
created consisting of Laparoscopic oncology helped us to get oriented with the anatomy of
surgeons, Laparoscopic Gynaecological the uterine as well as the ovarian vessels. The
surgeons, Anaesthetists, High Risk plan was to anastomose the uterine vessel to
Obstetricians, Neonatologists, Infertility the external illiac vessels. We dissected the
Specialists, Endocrinologist, Nephrologist, hysterectomy specimen and mobilized the
Physicians, Plastic Surgeons and Vascular uterine vessels. The ovarian artery and vein
Surgeons, intensivist, psychiatrist, transplant were also dissected. The pedicle length in the
specimen were measured. length of
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