Recipient surgery for uterus transplantation from brain dead donor: a 10 steps video

Objective To describe, in a standardized 10-step approach, the surgical technique of uterus transplantation in a recipient using a graft retrieved from a deceased donor after brainstem death (DBD). Uterus transplantation has emerged as the only therapeutic option enabling women with absolute uterine factor infertility to achieve pregnancy and childbirth. Although the procedure has progressively evolved over the last decade, it remains one of the most technically demanding transplant procedures, requiring meticulous vascular dissection, complex pelvic reconstruction, and close multidisciplinary collaboration. Standardization of the recipient procedure is essential to improve reproducibility, facilitate surgical training, and optimize perioperative outcomes. This educational video presents the recipient operation in 10 consecutive steps, from pelvic preparation and vascular exposure to graft implantation, vascular anastomoses, vaginal anastomose, fixation of the graft, and final assessment of graft perfusion. The video highlights key technical landmarks and surgical tips that may help reduce operative complexity and contribute to the dissemination of uterus transplantation programs. Design This video article shows all the technical details for uterine transplantation recipient surgery using uterus retrieval from brain-dead donor. Setting University, clinical trial. Intervention A uterus retrieved from a deceased donor after brainstem death (DBD) was prepared on the back table and transplanted into a recipient with absolute uterine factor infertility. The video demonstrates the recipient procedure using a standardized 10-step approach, including pelvic preparation, exposure of the iliac vessels, graft positioning, venous and arterial vascular anastomoses, restoration of blood flow, vaginal anastomosis, fixation of the uterus, and final assessment of graft perfusion and anatomical positioning. Main outcome measures Feasibility and reproducibility of a standardized 10-step recipient surgical technique, successful completion of vascular and vaginal anastomoses, restoration of uterine perfusion after reperfusion, and immediate intraoperative assessment of graft viability. Results This educational video illustrates each of the 10 key surgical steps of uterus transplantation in the recipient following deceased donor procurement. The standardized surgical workflow presented was successfully applied in three consecutive clinical uterus transplantations using grafts retrieved from deceased donors after brainstem death, demonstrating its reproducibility in a real-world transplant setting. Particular emphasis is placed on pelvic exposure, graft orientation, and technical pearls that facilitate complex arterial and venous anastomoses while preserving graft integrity. Immediate reperfusion resulted in homogeneous graft revascularization, with restoration of normal uterine color and satisfactory perfusion confirmed by intraoperative assessment. By providing a structured and reproducible surgical roadmap, this video aims to facilitate training, promote technical standardization, and support the dissemination of deceased donor uterus transplantation programs. Conclusion Recipient surgery remains one of the most technically demanding components of uterus transplantation. A standardized stepwise approach may improve reproducibility, facilitate training of multidisciplinary transplant teams, and contribute to the safe dissemination of uterus transplantation from deceased donors.