Heterotopic autotransplantation of the ovary with microvascular anastomosis: a novel surgical technique.
OBJECTIVE
To test the feasibility of transplanting an entire ovary with anastomosis of the ovarian vascular pedicle.


METHODS
Long-term survival study.


METHODS
Biological Resources Unit, Cleveland Clinic Foundation.


METHODS
Five adult, nonpregnant ewes.


METHODS
Laparoscopic bilateral oophorectomy was performed. Ovaries were autotransplanted into the abdominal wall, and microsurgical vascular anastomosis of the ovarian to the inferior epigastric vessels was performed. The transplant was removed and evaluated after 7 +/- 1 days.


METHODS
Blood flow, serum E2 and FSH levels, and histologic characteristics.


RESULTS
At follow-up three transplants were viable; they showed no signs of necrosis, and patency of the vascular anastomosis was confirmed. Serum E2 levels did not change significantly after transplantation in the patent vessel group (155.3 +/- 46.1 vs. 125.7 +/- 44.6 pg/mL) or the nonpatent vessel group (99 vs. 158 pg/mL). Serum FSH level in the patent vessel group did not change significantly from before to after transplantation (70.6 +/- 37.2 ng/mL vs. 95.1 +/- 17.7 ng/mL), whereas a large increase in FSH level was observed in the nonpatent vessel group (52.3 ng/mL vs. 522 ng/mL). The patent vessel group had significantly more follicles after transplantation than did the nonpatent vessel group (6 +/- 1 vs. 1 +/- 1).


CONCLUSIONS
In conjunction with improved protocols for cryopreservation, ovarian autotransplantation with vascular anastomosis may be superior to current ovarian tissue banking and grafting techniques.
Jeremias
Elisabeth
E
Department of Obstetrics and Gynecology, Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Bedaiwy
Mohamed A
MA
Gurunluoglu
Raffi
R
Biscotti
Charles V
CV
Siemionow
Maria
M
Falcone
Tommaso
T
D000714:Anastomosis, Surgical; D000818:Animals; D001808:Blood Vessels / Q000473:pathology; D004958:Estradiol / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006085:Graft Survival; D008833:Microcirculation; D009336:Necrosis; D010053:Ovary / Q000098:blood supply* / Q000473:pathology / Q000637:transplantation*; D012756:Sheep; D013997:Time Factors; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D014654:Vascular Patency
D004958:Estradiol; D005640:Follicle Stimulating Hormone