Objective

To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold.

Design

Case series with meta-analytic update.

Setting

Academic.

Patient(s)

Seven recipients of RA-ACOTT.

Intervention(s)

Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7–12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case.

Main Outcome Measure(s)

Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data.

Result(s)

Ovarian function returned 13.9 ± 2.7 weeks (11–16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation.

Conclusion(s)

In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.

中文翻译：

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机器人手术卵巢移植和新生血管化人细胞外基质支架：与荟萃分析数据比较的病例系列

客观的

报告我们使用新血管化细胞外基质支架进行机器人辅助 (RA) 自体冷冻卵巢组织移植 (ACOTT) 的经验。

设计

具有元分析更新的案例系列。

环境

学术的。

病人）

RA-ACOTT 的七名获奖者。

干预措施

在开始化疗之前或之后不久，将 7 名女性的卵巢组织冷冻保存，然后在 9.9 ± 1.8 年（范围，7-12 年）后接受 RA-ACOTT。围手术期，他们接受经皮雌激素和低剂量阿司匹林以增强移植血管形成。将卵巢皮质片解冻并缝合在细胞外基质支架上，然后在 6 例中将其与双壳剩余卵巢机器人吻合，在 1 例中通过腹膜后（异位）吻合到下腹部。

主要观察指标）

记录卵巢功能恢复、卵母细胞/胚胎数量、非整倍体百分比、活产和新生儿结局。将移植物寿命与荟萃分析数据的平均值进行比较。

结果）

ACOTT 后 13.9 ± 2.7 周（11-16.2 周）卵巢功能恢复，所有病例均获得卵母细胞，产生 12.3 ± 6.9 个胚胎。与原位相比，异位 ACOTT 表现出较低的胚胎质量和 80% 的非整倍体率。接受者没有尝试怀孕，2 人需要代孕，而 4 人中有 4 人分娩了 6 个健康的孩子，而根据元分析数据 (n = 79)，460 人中有 115 人（怀孕率为 25%）。平均移植物寿命（43.2 ± 23.6/47.4 ± 22.8 个月，有/没有敏感性分析）趋势比元分析平均值 (29.4 ± 22.7) 更长，即使在匹配冷冻保存年龄后也是如此。

结论

在这个系列中，RA-ACOTT 延长了移植物的寿命，所有病例的卵巢功能都恢复了，即使组织在化疗暴露后被冷冻保存。