There are a number of ‘spin-offs’ directly related to gynaecological practice which have arisen from our transplantation research. They include the first case of fertility sparing surgery for a giant adenomatoid tumour of the uterus, a tumour previously managed by hysterectomy and a successful cessation of bleeding in a patient with a ruptured cornual ectopic pregnancy without need of hysterectomy.
Also, some of the techniques have proved useful in the surgical management of Gestational Trophoblastic Disease, as well as the treatment of womb arterio-venous malformation. Finally, the idea of radical abdominal trachelectomy, a fertility-sparing surgery for early stage cervical cancer, was first proposed by Richard Smith and his colleagues in 1997, is now very much a part of the surgical process behind womb transplantation.
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Thousands of patients helped by breakthroughs resulting from UK Womb Transplant Research
Thousands of woman around the world facing a number of serious conditions, including gynaecological cancers, are now being offered new treatments resulting from innovative solutions developed by the UK Womb Transplant team.
The breakthroughs, following two decades of research by the team lead by Professor Richard Smith, can now in many cases, preserve the fertility of women of child bearing age and in some cases potentially save lives. In addition, the team has announced its research into potential new treatments for Ashermans syndrome is beginning to show good progress.
The growing incidence of Absolute Uterine Factor Infertility (AUFI) which currently affects one woman in 500 of child bearing age – that’s 15,000 women in the UK alone – has been the focus of the team’s research for many years. Only a minority of these patients would be eligible for a womb transplant.
The procedures developed by the team include the following:
Radical Trachelectomy
Until recently patients, many of child bearing age diagnosed with cervical cancer had little choice but to have a hysterectomy. The team developed the procedure to spare the uterus and preserve fertility. This procedure has also been carried out on a number of women who were pregnant, saving the life of mother and baby. Thousands of women worldwide have benefitted from this procedure.
Modified Strassman Procedure
The team have further developed the surgical procedure to remove placental site tumours – tumours arising from cells of the placenta after a pregnancy, by temporarily closing off the uterine artery, removing the tumour and then restoring the blood supply enabling patients to have successful pregnancies.
Exploring New Surgical Techniques
The UK Womb Transplant team’s early work included publishing its research on a procedure called the ‘large vessel patch technique’ which was the method used originally in both living donor womb transplants and in deceased donor transplants.
The patch technique is where surgeons use large arteries to supply an organ with blood and large veins to drain it. This technique gives a very good blood supply but involves extensive surgery and it is still used in deceased donor transplants.
The new technique uses large arteries (large vessel patch) but the veins to drain the blood from the uterus are small, rather than large This technique was pioneered by the UK team’s US collaborators, Professor Liza Johannesson and colleagues, at the Baylor Scott White Institute in Dallas, Texas. (Baylor has the world’s largest live donor womb transplant programme.) This innovative technique has greatly reduced the time taken to remove the uterus in living donors, making it a safer procedure by reducing the risk of deep vein thrombosis.
Professor Johannesson’s innovation, which has had a marked improvement in safety, is the reason why the UK team decided to begin a programme of live donor operations
Other areas of the team’s research focus on painful and fertility threatening endometrial conditions
Endometrial Transplant
The condition known as Ashermans Syndrome – widespread scarring inside the womb can lead to partial or complete failure of the endometrium leading to 5% of infertile women. This is a permanent injury to the lining of the womb that can only be rectified by a womb transplant or potentially, a transplant of the endometrium, (ETx.)
The feasibility of ETx has been proven by the UK Womb Transplant Team, involving endometrial auto-transplantation in the rabbit model, suggesting possible new treatments for women with Ashermans syndrome.
Tissue Engineering and the Development of Hydrogel
The team is also researching regenerative medicine approaches to treat Ashermans syndrome. In collaboration with Professor Molly Steven, We have developed a novel biomaterial that helps to stimulate the endometrium to heal in a healthy manner, instead of forming scarring, following trauma to the uterus, similar to that sustained during surgery. Our laboratory results have shown that this new biomaterial promotes cell and tissue repair in the endometrium, and we are now working step-by-step towards translating this into a clinical treatment to benefit patients at risk of uterine factor infertility.
Team Leader, Professor Richard Smith said the magnitude of the distress and pain resulting from various causes of infertility was under-recognised in society. “Infertility is a growing problem in the UK and elsewhere and the damage it causes in society deserves more attention.”
“Our team is delighted to be making real progress and seeing thousands of women getting the benefits both here in the UK and abroad but there is so much still to do and more and more women who need help. Womb transplants can and will help a number of women overcome AUFI but we must find additional solutions to conditions such as endometriosis.”