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| Experimental surgery that preserves the ability of women with cancer to become mothers |
Cancer does not cause infertility unless specific female organs are directly affected by the disease. However, fertility may be affected in women undergoing radiotherapy.
Retan Ribeiro has developed a technique called 'Uterine Transposition' with this point in mind. The experimental technique, which has been adopted at Brazil's Institute of Robotic Surgery, aims to preserve the fertility of women undergoing radiotherapy.
Under this method, certain organs including the uterus of women are moved from their place to another place so that they are not directly affected during the therapy. After treatment, these organs, including the uterus, are moved back to their original location.
This experimental technique has recently been taken advantage of by 33-year-old makeup artist Karim dos Santos.
In June 2018, he was diagnosed with liposarcoma. It is a rare cancer that originates in the fatty tissue of the body.
He was told that he would need surgery but later radiotherapy. However, this treatment will affect their uterus and affect their ability to conceive.
She says that at that time I was not in a relationship with anyone nor did I have children, but after the age of 30 I planned to start a family. Therefore, this news was quite bad.
It was during this time that he learned about research into a treatment called uterine transposition.
"The doctor made it clear to me that this is just a study and so far no woman has gotten pregnant through it and he can't guarantee anything," she says. I got the surgery done.
"The first 15 days after the surgery were quite painful, but there were no other complications," Karim said.
Three months after the completion of radiotherapy, their organs were transplanted back to their original place.
He was later diagnosed with two more cancers, one of which was in his lungs. She underwent treatment and according to her met her future husband in 2021.
"When I was finishing my treatment, I found out I was pregnant."
'Now that I think about it, I think it was the best decision of my entire life because I really enjoyed being a mother.'
Cervical cancer
In 2020, 33-year-old Angelica was also diagnosed with cervical cancer.
She says that the doctor first said that he would remove the uterus, but by then my cancer had not spread so far. I considered the alternative.
She says that it was very difficult for her to accept that with the disease, she would not be able to fulfill her dream of becoming a mother.
"I was very worried because maybe a woman doesn't want to be a mother, but when someone tells you that you can't have children, you have no choice."
"I had the option of stopping treatment and becoming pregnant or losing the ability to have children because I had to have radiotherapy," she says.
In such a situation, he also came to know about this experimental surgery. "At first I was unsure because it was a completely new research and I wasn't sure if it would work," she says.
Nevertheless, he underwent the surgery, and 15 days later, the cancer was treated with chemotherapy and radiotherapy.
"After a week of chemo and radiotherapy, I had another operation and then the recovery process went perfectly."
In October 2021, she decided that it was time to become a mother. The following year, she became pregnant.
She says it was a very good decision to have the surgery.
What is Uterine Transposition?
This surgery is done with robotic technology in which the uterus, fallopian tubes, and ovaries are removed and placed slightly above so that they are not damaged by radiotherapy.
This is because radiotherapy can reduce the ability to get pregnant.
Brazilian surgeon Ribeiro, the inventor of this technique, says that there are no risks in this operation and the patient is sent home in one to two days.
He says that after the operation there is a feeling of pain or discomfort, but the patient can lead a normal life.
It should be noted that the uterus continues to function even after the operation, although it is not in its original position. However, after treatment, it is moved back to its original location.
This method is suitable for patients who have cancer of the bowel, bladder, and genitals or those who have sarcoma that occurs in muscles and for whom a few sessions of radiotherapy during treatment may reduce the ability to conceive.
Renato Moretti is the coordinator of the robotic surgery program. He says that in some cases this surgery should not be done.
The ovary or tube mustn't be affected by the disease. If the ovaries are not functioning in such patients, the uterus cannot be removed. Even if one has already undergone radiotherapy, it is not possible to perform this surgery.
Quality of life
Ribeiro says that the goal of cancer treatment is not only to cure the patient but also to ensure that their quality of life is the same as it was before treatment began.
He says, 'If someone has cancer in their leg, we will not amputate the leg, but we will try to fix it and the patient will be able to walk after recovery.'
Although many operations have been performed using this technique, however, so far this is an experimental technique.
In 2016 it was presented at an International Congress of Gynecology and will be published soon.
The first operation under this technique took place in 2015, since then it has been used in many countries including Germany, Russia, Argentina, Colombia, USA, and Israel.
Only in Brazil, 20 patients have undergone this operation. However, there are instances where this operation has not been successful.
"Right now we're in the third phase where a larger number of patients will be tested over a longer period," says Ribeiro, adding that there are many patients who haven't tried to conceive yet.
Only four hospitals in Brazil are allowed to perform this surgery.
"This surgery is only done in major hospitals with the approval of the National Research Ethics Committee because many people may question if it can be done, so yes, I can do it," says Ribeiro.