Surgical Aspects of Ovarian Tissue Removal and Ovarian Tissue Transplantation for Fertility Preservation

Abstract

Introduction: The removal of ovarian tissue prior to starting oncologic treatment and the subsequent transplantation of this tissue after completing therapy have become increasingly important surgical fertility-preserving techniques. The aim of this review was to investigate the different surgical techniques used for this method reported in the literature to date and to discuss the advantages and disadvantages of the respective techniques.

Review: A search was done in MEDLINE using a defined algorithm to find studies published between January 2004 and December 2015. All study designs were included in our review if they contained statements on the surgical technique used. We found 16 publications (8 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 1898 female patients which reported on the surgical technique used for ovarian biopsy and 15 publications (7 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 455 women which mentioned the surgical technique used for ovarian transplantation. Different surgical techniques can be used both for ovarian biopsy and for the transplantation of ovarian tissue. A number of different surgical routes have been used, and the amount of tissue extracted, the instruments used, the treatment of the ovary, the transplantation site, the blood supply to the transplanted ovarian tissue and the procedure used for simultaneous surgical interventions vary.

Conclusion: In future, one of the tasks will be to establish a standard surgical method for ovarian extraction and transplantation which will have a low rate of complications and a high pregnancy and birth rate while ensuring that the transplanted tissue is fully functional.

Zusammenfassung

Einleitung: Die Entnahme von Ovargewebe vor Beginn einer onkologischen Therapie und seine Transplantation nach Abschluss der Therapie sind operative fertilitätsprotektive Techniken mit stetig zunehmendem Stellenwert. Ziel dieses Reviews ist es, die verschiedenen operativen Techniken bei diesem Verfahren auf Grundlage der bisher veröffentlichten Literatur zu analysieren und ihre Vor- und Nachteile zu diskutieren.

Review: Zwischen Januar 2004 und Dezember 2015 publizierte relevante Studien wurden auf MEDLINE nach einem definierten Algorithmus gesucht. Es wurden alle Studiendesigns eingeschlossen, sofern eine Aussage zur operativen Technik getroffen wurde. Wir fanden 16 Publikationen (8 retrospektive Kohortenstudien, 6 Fallberichte und 2 systematische Reviews) mit insgesamt 1898 Patientinnen, in denen auf die operative Technik bei der Ovargewebsentnahme eingegangen wurde, und 15 Veröffentlichungen (7 retrospektive Kohortenstudien, 6 Fallberichte und 2 systematische Reviews) mit 455 Frauen, die sich mit der operativen Technik bei der Ovartransplantation beschäftigten. Es existieren verschiedene operative Techniken sowohl für die Entnahme als auch die Transplantation von Ovargewebe. So existieren verschiedene operative Zugänge sowie Variationen bei der Menge des extrahierten Gewebes, den verwendeten Instrumenten, der Versorgung des Ovars, der Lokalisation und Versorgung des Transplantats und bei der Durchführung simultaner operativer Eingriffe.

Schlussfolgerungen: Eine zukünftige Aufgabe wird es sein, für die Ovarentnahme und -transplantation eine standardisierte Operationsmethode zu etablieren, die mit einer niedrigen Komplikationsrate sowie einer hohen Schwangerschafts- und Geburtenrate bei guter Funktionalität des Transplantats einhergeht.

Key words

surgical techniques - ovarian tissue - fertility protection in cancer - fertility preserving techniques - oncofertility

Schlüsselwörter

operative Technik - Ovargewebe - Fertilitätsprotektion bei Krebserkrankung - fertilitätserhaltende Techniken - Onkofertilität

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