Robotic Surgery Chalks Up Another Historic Success

Score another historic success for robotic surgery. For the first time in the world, a baby has been delivered by cesarean section from a uterus transplant that took place earlier using only robot-aided surgery.

The historic breakthrough originally took place in October 2021. The uterus was successfully transplanted into the mother from a donor using robot-aided keyhole surgery on both the recipient and the donor. The donor is a relative.

Now that the baby has been born and that mother and child are both healthy, the research team at the University of Gothenburg in Sweden who conducted the original transplant are able to announce that the milestone procedure was successful in all its stages.

The mother is aged 35. The baby boy measured 19.3 inches and weighed 6 pounds, 13 ounces. Both are in good health.

Ultra-fine Surgery

Procedures such as the ultra-fine surgery involved in the transplant can now be performed using robot-assisted keyhole surgery, explains Dr. Niclas Kvarnström, of the Department of Surgery at the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg.

The overall goal of the evolution in surgery is to lessen the trauma for the patient, he adds.

Benefits of Robots

The benefit of robotic surgery is that it is markedly less invasive than traditional open surgery, the researchers explain. In traditional open surgery the risk of hemorrhage and infection are higher than they are using robotic surgery.

Patients who have been operated on using robotic surgery also usually are back on their feet more quickly than in cases of traditional surgery.

The technique enables operations deep down into the pelvis, explains Dr. Perilla Dahm-Kähler who is adjunct professor of obstetrics and gynecology at Sahlgrenska Academy at the University of Gothenburg. She was the leading surgeon in the intricate procedure that was conducted on the recipient.

She sees the operation as the “surgery of the future,” adding that the team is pleased and proud to have been able to develop uterine transplants to this technically minimally invasive level.

The keyhole method involves inserting robotic arms and cameras through small entry holes that are made in the lower belly. Surgical instruments are attached to the robotic arms. The surgeons move the robotic arms using tools that resemble the joysticks that airplane pilots use. They can operate with great precision and see mobile 3D images of what they are doing.

How This Surgery was Done

The transplant of the uterus from the donor to the recipient took place at Sahlgrenska University Hospital in Sweden in October 2021.

The uterus was removed from the donor in a series of steps using robotic surgery. In the final step the donor’s uterus was removed from the blood vessels feeding it through the donor’s vagina. It was placed in a laparoscopic pouch.

The donor’s uterus was then inserted into the recipient through a tiny insertion in the pelvis. It was connected by being sewn into the woman’s blood vessels and then into the vagina and supportive tissue.

All the steps were conducted using robotic surgery.

Pregnancy Confirmed

Ten months later, an embryo developed through in-vitro fertilization was inserted into the uterus that had been transplanted into the recipient. A few weeks later it was confirmed that she was pregnant.

The mother-to-be felt well throughout her pregnancy.

The entire procedure has now ended with the planned cesarean section that took place in the thirty-eighth week of her pregnancy.

All aspects of the procedure were pronounced successful.

Fourteenth in Project

The baby is the fourteenth to be born in the uterus transplant project at the Sahlgrenska Academy, but it is the first using only robots. More births are awaited this summer.

The research project regularly evaluates recipients, donors, and babies after the uterus transplant for several years afterward. The reason they do so is to render the surgery as efficient as possible as well as to lessen the side effects on the patients as much as possible, says Dr. Mats Brännström, of the Department of Obstetrics and Gynecology at the Sahlgrenska Academy.

The world’s first birth following a uterus transplant took place in 2014. Eight such births took place in Sweden before anyone outside the country delivered a baby after receiving a uterus transplant.

Shared Technique

The university team shared their technique and methods with other medical centers globally. Since then about 90 uterus transplants have taken place around the world. Some 50 babies have been born as a result.

Now the research team at the university has become the first in the world to conduct the complicated uterus transplant entirely using robotic surgery.