Fallopian tube perfusion in ex-vivo and in-vivo laparoscopic hysterectomy specimens: potential application for uterine transplantation

• Published in: Human reproduction (Oxford) Vol. 33; no. 12; pp. 2232 - 2240
• Main Authors: Farag, Sara, Frazzini Padilla, Pamela, Smith, Katherine A, Flyckt, Rebecca, Sprague, Michael L, Zimberg, Stephen E
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-12-2018
• Subjects: vascular perfusion; uterine transplantation; laser angiography; indocyanine green; fallopian tubes
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/dey307

Abstract
STUDY QUESTION
Is there perfusion to the fallopian tubes in ex-vivo and in-vivo uteri at the time of total laparoscopic hysterectomy (TLH), as observed using laser angiography with indocyanine green (ICG)?
SUMMARY ANSWER
The fallopian tubes may have perfusion from the utero-ovarian vasculature alone.
WHAT IS KNOWN ALREADY
The fallopian tubes are perfused by the uterine and utero-ovarian vessels. Perfusion can be measured using laser angiography with ICG.
STUDY DESIGN, SIZE, DURATION
This prospective pilot cohort study included 15 women, ages 32-59 years old, who underwent TLH with bilateral salpingectomy for benign indications.
PARTICIPANTS/MATERIALS, SETTING, METHODS
In five participants, TLH was performed and the utero-ovarian artery was cannulated ex vivo and injected with ICG. The other 10 participants underwent the in-vivo protocol. The mesosalpinx and uterine vessels were transected in the partial protocol. Colpotomy was also performed in the complete protocol. All fallopian tubes were imaged using laser angiography with ICG. The relative fluorescence and the fluorescence intensity ratio (length of fluorescent fallopian tube/total length of fallopian tube) of the fallopian tubes were measured in the ex-vivo and in-vivo protocols, respectively.
MAIN RESULTS AND THE ROLE OF CHANCE
Ex vivo, the fimbria of the ipsilateral fallopian tube had 47% median relative fluorescence as compared to the contralateral fallopian tube, which had 2.4% median relative fluorescence. In vivo, the post-ICG fluorescence intensity ratios were 0.61 ± 0.40 for the partial protocol, and 0.78 ± 0.30 for the complete protocol, with mean differences of 0.37 (95% CI: 0.23-0.50, P < .0001) and 0.22 (95% CI: 0.12-0.31, P < 0.0001), respectively, between the pre-procedure and the post-ICG fluorescence intensity ratios. Greater than 0.75 fluorescence intensity ratios (i.e. >75% tubal length fluorescence) was seen in 60% of fallopian tubes.
LIMITATIONS, REASONS FOR CAUTION
This is a pilot study with a small sample size and pathologic uteri, which would not be appropriate for uterine transplantation. No conclusions can be made regarding the functionality of the fallopian tubes.
WIDER IMPLICATIONS OF THE FINDINGS
The fallopian tubes may have perfusion with the utero-ovarian vasculature alone, potentially allowing for future animal studies regarding tubal viability in recipients of uterine-tubal transplants. If successful, human uterine-tubal transplantation may allow for spontaneous conception rather than IVF.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was used. S.F., P.F.P., K.A.S. and R.F. have no conflicts of interest to report. M.L.S. is an educational consultant for Medtronic (Dublin, Republic of Ireland) and Applied Medical (Rancho Santa Margarita, CA, USA), as well as a stockholder for SynDaver Labs (Tampa, FL, USA). S.E.Z. is an educational consultant for Applied Medical (Rancho Santa Margarita, CA, USA) and is on the advisory board for AbbVie Inc. (Chicago, IL, USA).
TRIAL REGISTRATION NUMBER
Not applicable