Robotic-assisted living-donor hysterectomy for uterus transplantation: a systematic review of surgical techniques, donor safety, and recipient outcomes.

In 30 seconds

This systematic review assessed robotic-assisted hysterectomy in living donors for uterus transplantation, examining surgical methods, donor safety, graft outcomes, and reproductive success. Six studies from five countries reported 29 unique procedures, all using the da Vinci Xi platform. Operative time and estimated blood loss declined with increasing experience, and major donor complications were less frequent in later series. No graft loss was reported among cases with follow-up; pregnancies and live births occurred, including ten live births in the largest programme. The authors describe the approach as feasible in selected cases but emphasise that evidence is limited and donor morbidity remains uncertain.

Key findings

• Six studies reported 29 unique robotic-assisted living-donor hysterectomies across five countries; all used the da Vinci Xi platform.
• Operative time and estimated blood loss decreased with increasing surgical experience.
• No graft loss was observed among cases with reported follow-up; reproductive outcomes included ten live births in the largest programme.
• Major donor complications included ureteric injury requiring reimplantation and bilateral oophorectomy.

Why it matters

Uterus transplantation can enable pregnancy for women with absolute uterine factor infertility, but donor procurement is technically demanding and donor safety is central. This review indicates that robotic procurement has been followed by viable grafts and successful reproductive outcomes in selected cases, while also documenting serious complications. The findings help frame the balance between potential benefit and uncertain donor risk.

What to keep in mind

Evidence comprised only six small observational studies and 29 unique procedures. The true incidence of donor morbidity remains uncertain.