UK’s first womb transplant: Step by step of the complex procedure from the surgeons who did it
ITV News' Lucy Watson explains how a first-of-its-kind womb transplant surgery has been hailed a success
A woman has been given a womb by her older sister in the first surgery of its kind in the UK.
The 34-year-old married woman received the organ – also called the uterus – during a nine hour and 20 minute operation at the Churchill Hospital in Oxford.
Its success was down to meticulous research and years of sharing knowledge between experts around the world.
Professor Richard Smith, from Imperial College Healthcare NHS Trust and Imperial College London, and Isabel Quiroga, from the Oxford Transplant Centre at Oxford University Hospitals NHS Foundation Trust, were the surgeons behind the transplant.
Here's exactly how they completed the tricky surgery.
Where did the womb come from and how was it removed?
The woman's sister donated her womb. At 40 years old, she has completed her family and has two children.
Before surgery, both sisters had extensive counselling.
They were reviewed by gynaecologists, transplant surgeons, obstetricians, psychologists, anaesthetists and pharmacists.
Removing a womb is similar to a radical hysterectomy, according to gynaecological surgeon Prof Smith.
He said: “The day itself was truly humbling. We turned up at 7am at the Churchill transplant centre with the donor and the recipient families, then we went into a pre-op huddle.”
Those in the huddle included surgeons, nurses, anaesthetists and technicians.
He and Miss Quiroga removed the older sister’s womb, cervix and fallopian tubes, plus crucial blood vessels around the organ.
The main vessels are the uterine arteries running into the womb, but the surgeons also aimed to collect some of the larger internal vessels that lead into the smaller branch of the womb.
Prof Smith said surgeons have to retrieve veins involved in the drainage of the womb.
Prof Smith and Miss Quiroga worked to remove the womb, before the organ was prepared for transplantation by a “back table” team.
“This was an organ which had a very, very unusual blood supply,” Prof Smith said.
“In fact, it had a set of blood vessels which I’ve never seen in my entire career.
“They made my dissection a bit harder than it might have been, but we got there.”
How did they complete the transplant?
In the theatre next door, one hour before the retrieval was completed, surgeons began to operate on the donor’s younger sister to ready her to receive the womb.
Prof Smith and Miss Quiroga switched from donor to recipient and Prof Smith removed the remainder of the underdeveloped womb.
Meanwhile, the donated organ was packed in a sterile bag with a cold perfusion solution and was placed into a container with ice to be transported between the two theatres.
During surgery, ligaments attached to the womb were attached to the recipient to help it stay in a relatively fixed place so it does not move around the pelvis.
The most important part of the transplant operation was the joining of the very small vessels that give the blood supply to the womb.
This was the most delicate and difficult part of the operation and was led by Miss Quiroga.
For this operation, two arteries and three veins were joined in total to achieve the best blood supply and drainage of the womb.
Once all the vessels were connected, the donor’s vaginal cuff – around a 1cm part – was stitched into her sister’s vagina.
If and when the recipient is able to complete her family, the womb will be removed six months later to prevent her from needing immunosuppressants for the rest of her life.
Was it a risky operation?
Prof Smith said he had been “very” confident the transplant would work, adding: “You couldn’t do this if you thought there was a prospect of failure.
“Did we think we could do it? Of course, but we know that the chance of failure at the point where the uterus goes in – if you look at the world literature – is 20% to 25%.
“And that failure is usually on the basis of sepsis and thrombosis.
“So technically, we are up to the job, but what happens thereafter can be scary.
“Once you get to three or four days later, the chance of failure drops to probably less than 10%.
“Once you get to two weeks – and at the point where the woman has a period – the chance of her having a baby at that point is very high and the chance of failure has dropped to low.
“But those first two weeks – it’s very scary as a surgeon to watch and wait.”
Biopsies to check the womb was functioning were read in London but then also confirmed by an expert team in the US at Baylor University Medical Centre in Dallas, where other womb transplants have been performed.
Miss Quiroga said she was “thrilled”, adding that, following the operation, transplant staff were still cautiously taking it all in.
She said: “It was a very proud moment but still quite reserved – the first two weeks after the operation are nerve-racking.
“Now, I feel extremely proud of what we’ve achieved and desperately happy for her.”
Miss Quiroga said the patient was “incredibly happy”, adding: “Her womb is functioning perfectly and we are monitoring her progress very closely.”
Why didn't she have a womb?
The woman receiving the womb was born with Mayer-Rokitansky-Kuster-Hauser (MRKH), a rare condition that affects around one in every 5,000 women.
In MRKH, women have an underdeveloped vagina and underdeveloped or missing womb. The first sign of the condition is when a teenage girl does not have periods.
However, their ovaries are intact and still function to produce eggs and female hormones, making conceiving via fertility treatment a possibility.
Can she have a baby now?
Before receiving her new womb, the woman had two rounds of fertility stimulation to produce eggs, followed by intracytoplasmic sperm injection (ICSI) to create embryos.
Eight embryos have reached blastocyst stage – which means they have a good chance of success in IVF – and were frozen for when the patient undergoes treatment at the Lister Fertility Clinic in central London later this year.
Prof Smith said that, at present, the transplanted womb is “functioning exactly as it should” and the plans for IVF are on track.
Prof Smith said he was looking forward to when the patient can undergo IVF.
“Hopefully that embryo will take, and hopefully nine months later she’ll (have a) Caesarean section,” he said.
“Once she’s had a Caesarean section, she does have a choice – six months later – of a complete hysterectomy or to go and have another baby.
“We know right now she wants to have another baby, that’s for sure.”
Miss Quiroga said: “The reason why we’re waiting and not going straight for IVF is because we want to make sure she’s stable and the transplant is stable, and so far she’s been very, very stable.”
Was the surgery on the NHS?
No, the transplant cost around £25,000 and was paid for by donations to the Womb Transplant UK charity, for which Peter Smith is the clinical lead.
This included paying the NHS for theatre time (the transplant happened when the operating room was not being used for NHS work), plus the patient’s hospital stay.
Surgeons and medical staff involved in the transplant were not paid for their time.
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What does it mean for people without wombs who would like one?
Prof Smith said the procedure gives new hope to women born with devastating conditions.
He said: “You’ve got girls, maybe 14, who have not had periods, they go to the GP and a scan shows there is no uterus. Absolute catastrophe.
“Up until now there’s been no solution for that, other than adoption or surrogacy… That’s not the case now. It’s really exciting.”
On whether transgender women may also benefit from the operation, Prof Smith said that was around 10 to 20 years off.
He said the pelvic anatomy, vascular anatomy and shape of the pelvis are different, and there are microbiome issues to overcome.
Miss Quiroga said the living donor programme to date in the UK has focused on women with relatives who are willing to give their wombs.
“It will come to a point where we will have friends or altruistic donors, like we have with many other transplants, but at the moment we’re only focused on people who have come forward with relatives,” she said.