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| Courtesy: University of Queensland. |
Uterine transposition
is an interesting and novel technique not ever reported in literature. This is
the first case report of uterine transposition and technique published in August issue of Journal Fertility and Sterility.
All
gynecologists are familiar with transposing ovaries to preserve fertility and
avoid premature menopause in patients who require radiation treatment to the
pelvis for cervical cancer.
Dr Reitan
Ribeiro from Brazil reports the case of a 26-year-old woman diagnosed with rectal
adenocarcinoma located 5 cm from the anal margin. The patient was young and did
not have any children and wanted to preserve her fertility.
Dr Ribeiro
offered the patient a repositioning of the uterus outside the pelvic cavity
called along with the ovaries outside the pelvic cavity, to save them from harm
due to pelvic radiation.
The maximum
tolerated radiation dose for the ovaries is 15 Gy; for uterus and cervix it is 20
Gy to 30 Gy. But, the radiation dose for curing rectal cancer is significantly
higher and is approximately 50 Gy, at which all the pelvic organs will be
certainly damaged.
After the
radiation treatment was complete the uterus was repositioned back into the
pelvic cavity.
The entire
procedure was carried out laparoscopically (key hole surgery) without a big
abdominal incision. The basis for this procedure is that the blood vessels to
the ovaries provide also good blood supply for the uterus at the same time.
The uterus
and ovarian functions were preserved as evident by 2 menstrual period that
began after 2 weeks of repositioning the uterus back and the cyclic ovarian hormonal
variation was maintained at the time of neoadjuvant therapy.
At per
speculum examination at 6 weeks the cervix was entirely normal looking and at
18 months follow up the uterus appeared to be normal.
The paper
was also presented by Dr. Ribeiro at Society of Gynecologic Oncology 2017Annual Meeting from 10 to 14 March in Washington D.C.
He did acknowledge
that further studies are warranted to establish the safety and efficacy of the
procedure. The spread of tumor to a location not easily amenable to treatment was
a major concern.
Dr Riberio
and colleagues have launched a Uterine Transposition: Feasibility Study and will shortly start recruiting patients.
This
prospective nonrandomized multicenter phase I study, will evaluate the
feasibility of performing uterine transposition before chemoradiation for
rectal cancer and uterine reimplantation after the treatment.
The authors
concluded that, “Uterine transposition might represent a valid option for
fertility preservation in women who require pelvic radiotherapy and want to
bear children.”
Related
link: Ovarian Transposition: A novel laparoscopic surgical method video by
Cleveland Clinics.
