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Autologous heterotopic fresh ovarian graft: technique description
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  1. Marília Albanezi Bertolazzi,
  2. Rodrigo Pinto Fernandes,
  3. Maria Luiza Nogueira Dias Genta,
  4. Edmund Chada Baracat and
  5. Jesus Paula Carvalho
  1. Gynecology Oncology, University of São Paulo, São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Marília Albanezi Bertolazzi, Gynecology, University of São Paulo, São Paulo, Brazil; marilia.bertolazzi{at}gmail.com

https://doi.org/10.1136/ijgc-2023-004430

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    Context

    Pelvic radiotherapy has several side effects, including premature ovarian insufficiency. Premature ovarian insufficiency has consequences such as loss of bone mass, genitourinary atrophy, increased risk of osteoporosis, and cardiovascular and neurodegenerative diseases in the mid- and long-term, beyond the negative impact on life quality.1

    Alternatives to preserve ovarian function have emerged.2 ,3 4 This article describes a technique of autologous heterotopic fresh ovarian graft. This procedure implies engrafting of fresh ovarian tissue in a site away from the radiotherapy field. The technique is simple, low-cost, and potentially can minimize the sequelae of radiotherapy in cervical cancer.

    Patient preparation

    The ideal patient position is semi-gynecologic. It is essential to adjust the positioning of the legs and access the lower limbs.

    Technique description

    1. Prior to radiotherapy, the patient undergoes laparoscopic unilateral salpingo-oophorectomy. An inventory of the abdominal cavity is performed. The procedure is interrupted by peritoneal carcinomatosis or ovarian tumor involvement. The selected ovary is the one with the usual morphology and free of adhesions. The ovary is removed from the abdominal cavity and protected by an EndoBag. If necessary, the port should be enlarged to minimize the injury/ischemia of the tissue.

    2. The ovary is sectioned into 1–2 mm slices. The section must be parallel to the axis of the greatest diameter of the ovary.

    3. Host site preparation: a transverse incision of approximately 3 cm is made on the inner side of the thigh, 12–14 cm away from the inguinofemural fault.

    4. Four cardinal spaces are created in the subcutaneous tissue, just below Scarpa’s fascia. Local hemostasis is reviewed, and five slices of ovarian tissue are accommodated into the site.

    5. Scarpa’s fascia is closed with slow absorption thread, and the skin edges are approximated with esthetic suture.

    6. Long-acting local anesthetic is infiltrated into the site.

    Graft reperfusion time ranges from 6 to 16 weeks. Blood flow assessment by Doppler ultrasound should be performed during postoperative follow-up.

    Video 1 Autologous heterotopic ovarian graft in subcutaneous tissue.
    Figure 1
    Figure 1

    Autologous heterotopic ovarian graft in subcutaneous tissue.

    Data availability statement

    Data are available upon request.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study involves human participants and was approved by Comissão de Ética para Análise de Projetos de Pesquisa CAPPesq - Hospital das Clinicas da Universidade de São Paulo (ID: 54996222.9.0000.0068). Participants gave informed consent to participate in the study before taking part.

    References

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      . Quality of life characteristics inpatients with cervical cancer. Eur J Cancer 2012;48:3009–18. doi:10.1016/j.ejca.2012.05.011
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      2. Yin L ,
      3. Lu S ,
      4. Zhu J , et al
      . Ovarian transposition before radiotherapy in cervical cancer patients: functional outcome and the adequate dose constraint. Radiat Oncol 2019;14:100. doi:10.1186/s13014-019-1312-2
    3. ↵
      2. Silber S ,
      3. Pineda J ,
      4. Lenahan K , et al
      . Fresh and cryopreserved ovary transplantation and resting follicle recruitment. Reprod Biomed Online 2015;30:643–50. doi:10.1016/j.rbmo.2015.02.010
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      2. Damásio L ,
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      4. Iavelberg J , et al
      . Heterotopic ovarian transplantation results in less apoptosis than orthotopic transplantation in a minipig model. J Ovarian Res 2016;9:14.: . doi:10.1186/s13048-016-0223-1
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    Footnotes

    • Contributors All the authors reviewed and approved the final version of this article and the accompanying video. MAB is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.