Advertisement

Laparoscopic ovarian tissue harvesting and orthotopic ovarian cortex grafting for fertility preservation: less is more

      Objective

      To describe our surgical techniques for laparoscopic ovarian tissue harvesting and orthotopic ovarian cortex grafting (LOOCG).

      Design

      This video article uses surgical cases to demonstrate the detailed surgical techniques. Institutional Review Board approval was not required for this video presentation.

      Setting

      University hospital.

      Patient(s)

      Patients presenting with indication for fertility preservation by means of ovarian tissue harvesting and orthotopic ovarian cortex grafting (in case of setting up a high risk of gonadotoxicity treatment or patients presenting with a pathology with risk of premature ovarian failure).

      Intervention(s)

      Ovarian tissue harvesting: The entire ovary is harvested by placing an EndoGIA stapler to ensure the control of infundibulopelvic ligament and then, after reloading, the section of the mesovarium. LOOCG one-step procedure: A large and superficial incision of the peritoneum is performed to create a peritoneal pocket. The fragments of ovarian cortex are secured with the use of nonresorbable surgical wire (Prolene 5.0) and introduced into the peritoneal pocket. The peritoneum is not closed after placing the graft.

      Main Outcome Measure(s)

      Value and feasibility of LOOCG. Restoration of endocrine function and fertility results.

      Result(s)

      Thirty-four patients were included from November 2011 to October 2017. LOOCG restored ovarian endocrine activity in 88.2% of cases. Ten patients had become pregnant (29.4%), and the same number gave birth to at least one child.

      Conclusion(s)

      Our surgical approach is simple, safe, and reproducible and seems to be as effective as previously described techniques. It deserves to be proposed to patients eligible for ovarian cortex grafting.
      Recolección laparoscópica de tejido ovárico e injerto ortotópico de corteza ovárica para preservación de fertilidad: menos es más.

      Objetivo

      Describir nuestras técnicas quirúrgicas de recolección laparoscópica de tejido ovárico e injerto ortotópico de corteza ovárica (LOOCG)

      Diseño

      Este video-artículo utiliza casos quirúrgicos para demostrar las técnicas quirúrgicas detalladas. La aprobación del Consejo de Revisión Institucional no fue requerida para la presentación de este video.

      Escenario

      Hospital Universitario

      Paciente(s)

      Pacientes con indicación de preservación de fertilidad a través de recolección laparoscópica de tejido ovárico e injerto ortotópico de corteza ovárica (en caso de tratamiento con alto riesgo gonadotóxico y pacientes que presentan una patología con riesgo de fallo ovárico precoz).

      Intervención(es)

      Recolección de tejido ovárico: El ovario completo es removido colocando una grapadora EndoGIA para asegurar el control del ligamento infundíbulo pélvico y posteriormente después de recargar, la sección del meso-ovario. El procedimiento LOOCG: Una incisión amplia y superficial en el peritoneo se realiza para crear un bolsillo peritoneal. Los fragmentos de corteza ovárica son fijados con sutura no absorbible (Prolene 5-0) e introducidos en el bolsillo peritoneal. El peritoneo no se cierra después de colocar el injerto.

      Medida de resultado principal

      El valor y la factibilidad de LOOCG. Restauración de la función endocrina y resultados de fertilidad.

      Resultado(s)

      Treinta y cuatro pacientes fueron incluidas desde noviembre de 2011 hasta octubre de 2017. LOOCG reestableció actividad endocrina ovárica en 88,2% de los casos. Diez pacientes tuvieron embarazo (29,4%), y el mismo número tuvo nacimiento de por lo menos un niño.

      Conclusión(es)

      Nuestro abordaje quirúrgico es simple, seguro y reproducible y aparentemente tan efectivo como otras técnicas descritas previamente. Merece ser propuesto a pacientes elegibles para injerto de corteza ovárica.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Suggested Reading

        • Donnez J.
        • Dolmans M.M.
        • Demylle D.
        • Jadoul P.
        • Pirard C.
        • Squifflet J.
        • et al.
        Livebirth after orthotopic transplantation of cryopreserved ovarian tissue.
        Lancet. 2004; 364: 1405-1410
        • Donnez J.
        • Jadoul P.
        • Pirard C.
        • Hutchings G.
        • Demylle D.
        • Squifflet J.
        • et al.
        Live birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease.
        Fertil Steril. 2012; 98: 720-725
        • Donnez J.
        • Dolmans M.-M.
        Fertility preservation in women.
        N Engl J Med. 2017; 377: 1657-1665
        • Meirow D.
        • Ra'anani H.
        • Shapira M.
        • Brenghausen M.
        • Derech Chaim S.
        • Aviel-Ronen S.
        • et al.
        Transplantations of frozen-thawed ovarian tissue demonstrate high reproductive performance and the need to revise restrictive criteria.
        Fertil Steril. 2016; 106: 467-474
        • Jadoul P.
        • Guilmain A.
        • Squifflet J.
        • Luyckx M.
        • Votino R.
        • Wyns C.
        • et al.
        Efficacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases.
        Hum Reprod. 2017; 32: 1046-1054
        • Diaz-Garcia C.
        • Domingo J.
        • Garcia-Velasco J.A.
        • Herraiz S.
        • Mirabet V.
        • Iniesta I.
        • et al.
        Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study.
        Fertil Steril. 2018; 109: 478-485.e2
        • Gellert S.E.
        • Pors S.E.
        • Kristensen S.G.
        • Bay-Bjørn A.M.
        • Ernst E.
        • Yding Andersen C.
        Transplantation of frozen-thawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish cohort.
        J Assist Reprod Genet. 2018; 35: 561-570
        • Oktay K.
        • Aydin B.A.
        • Karlikaya G.
        A technique for laparoscopic transplantation of frozen-banked ovarian tissue.
        Fertil Steril. 2001; 75: 1212-1216
        • Oktay K.
        • Taylan E.
        • Sugishita Y.
        • Goldberg G.M.
        Robot-assisted laparoscopic transplantation of frozen-thawed ovarian tissue.
        J Minim Invasive Gynecol. 2017; 24: 897-898
        • van der Ven H.
        • Liebenthron J.
        • Beckmann M.
        • Toth B.
        • Korell M.
        • Krüssel J.
        • et al.
        Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates.
        Hum Reprod. 2016; 31: 2031-2041