Uterine transposition is a surgical technique first described by Dr. Reitan Riberio. This is fertility preserving surgery for patients with rectal/anal cancer requiring pelvic radiation. The uterus is transported out of the field of radiation and repositioned when radiotherapy is completed.
Case Report A 36 year old woman presented with new onset peri-anal pressure symptoms on a background of no significant medical history. Examination revealed a hard irregular circumferential rectal tumor from dentate line, 5 cm in length. Histology reported a moderately differentiated adenocarcinoma. TNM stage T3cN2bM0. This case was discussed at the colorectal multidisciplinary team meeting. A plan was made for fertility-preserving uterine transposition and formation of loop colostomy. The patient would then commence pelvic radiation with concomitant chemotherapy. Following this the patient would undergo interval abdomino-perineal resection (APR) with re-implantation of uterus plus adjuvant chemotherapy.
Procedure A video attached shows the procedure of uterine transposition and the subsequent respositioning. This was done laparoscopically, with ligation of the round ligaments and mobilisation of the gonadal vessels to the level of the kidney bilaterally. Uterine arteries were ligated and colpotomy performed. The uterus was then transported to the upper abdomen and fixed to the abdominal wall. A cervical stoma was then formed.
The second video demonstrates the repositioning of the uterus to the pelvis following the completion of radiotherapy. The round ligaments are reattached bilaterally. Intravenous Verdye was administered and preservation of the blood supply to the uterus was demonstrated through an infrared camera lens.
Conclusion Uterine transposition represents a novel approach to fertility preserving surgery.
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