Page 23 - Plasticos-Vol-3
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V O L 3 2019 I S S U E
We got a pedicle approximately 8 to 10 cm in all and uterine veins and ovarian vessels were
the specimen that we dissected. This pedicle identified, dissected, skeletonized, terminal
length was adequate and could reach the lateral openings prepared, and kept ready for
pelvic wall for anastomosis with the external anastomosis. The arteries were canulated with
illiac vessels. We used methylene blue dye to a No 24 Cannula and cold Custodial solution
perfuse the specimen on the bench during our was flushed through the organ. The infusion
preparation and we realized that dye used to of the Custodial fluid was continued till the
flush either the uterine or ovarian artery was flow from the vein was clear and devoid of any
perfusing the entire organ and draining from blood. Nearly 1000 ml fluid was flushed through
both the uterine and ovarian veins. This helped bilateral ovarian and internal illiac vessels.
us understand the anatomy as well as plan Small leakages in the vessel were clipped to
the anastomosis for the transplant. A total of prevent any bleeding after the anastomosis.
30 such dissections of uterine specimens were Throughout the procedure the organ was kept
done by our microvascular team. surrounded by ice slush and custodial solution.
Introduction to the Simultaneously preparation of the recipient
surgical procedure vessels was also done.
The Surgery Itself was divided in three parts-
Donor Surgery for organ retrieval, Bench
Surgery, and Recipient Surgery. All the
dissection in the donor surgery was performed
laparoscopically by the surgical team headed
by Dr Puntambekar. An incision was taken
to retrieve the organ and was handed over
for the bench surgery. The bench surgery
was basically a process to prepare the organ Preparation of the organ during Bench Surgery
for the transplant. The recipient surgery was
started simultaneously to prepare the bed. Recipient Surgery
Anastomosis was performed in the recipient
and after confirming the patent nature of the Preparation of bed in the recipient was
anastomosis the supports of the uterus were started laparoscopically. Bladder and rectum
sutured in place to hold the transplanted were separated and space was created for
uterus. the uterus. Stay sutures were taken on Round
The Microvascular team consisted of two Plastic Ligament, Vagina, and Sacral Promontory.
Surgeons, Dr Nikhil Agarkhedkar and Dr Giriraj Abdomen was opened with a midline vertical
Gandhi. Dr Sanjeev Jadhav was the Vascular incision and the donor uterus was transported
Surgeon in the team. The Microvascular team on a sterile trolley in the recipient OT. The
was involved in the Bench Surgery and the uterus was placed in the pelvic cavity in the
Vascular anastomosis in the recipient. anatomical orientation. Bilateral ovarian and
Bench Surgery uterine vessels were oriented for anastomosis.
The part of the external illiac vessels where
the anastomosis was to be performed was
The harvested Uterus was received on a prepared. Bilateral uterine arteries with cuff of
sterile trolley with a container having ice slush internal illiac artery(Donor) were anastomosed
and Custodial solution. The bench surgery with the external illiac arteries and perfusion
was performed under loupe magnification. restored.
The cuff of anterior division of Internal Illiac
artery was taken along with the uterus for
ease of anastomosis. The internal iliac artery
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