While thrombosis is the most common indication for graft failure and immediate hysterectomy of a transplanted uterus, there is no optimal method to monitor graft perfusion. In this feasibility study, a near-infrared spectroscopy probe that monitors local tissue oxygenation (StO2) was attached to four uterine cervices and three donor cervices at the time of hysterectomy and transplantation respectively. Real-time StO2 measurements were gathered at key surgical steps of the hysterectomies and uterus transplantations. The average StO2 for the sequential steps of a hysterectomy of baseline, ovarian vessel ligation, contralateral ovarian vessel ligation, uterine vessel ligation, contralateral uterine vessel ligation, and colpotomy was 70.2%, 56.7%, 62.1%, 50.5%, 35.8%, and 8.5% respectively. The average StO2 for the sequential steps of uterus transplantation of iliac vein anastomosis, iliac artery anastomosis, contralateral iliac vein anastomosis, contralateral iliac artery anastomosis, and vaginal anastomosis was 8.9%, 27.9%, 56.9%, 65.9%, and 65.2% respectively. As uterine blood supply decreases in a hysterectomy, the measured StO2 also decreases, and vice versa for uterus transplantation. Tissue oximetry may be a reliable, non-invasive means of monitoring perfusion of a uterine graft. Additional studies are needed to determine if these devices complement current assessments of uterine graft viability and salvage thrombosed grafts.

DB is employed by ViOptix, Inc.

NCT03307356

The ViOptix T. Ox Tissue Oximeters used in this study were provided at no cost by ViOptix, Inc.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of the University of Pennsylvania gave ethical approval of this work (UNTIL #827853, ViOptix #829582).

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