Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPGALVAO, Flavio Henrique FerreiraARAKI, JunFONSECA, Ana Bruna SallesCRUZ JR., Ruy JorgeLANCHOTTE, CinthiaWAISBERG, Daniel ReisCHAIB, EleazarNACIF, Lucas SoutoTRALDI, Maria Clara de CamargoMELLO, Estrella Bianco deANDRAUS, WellingtonCARNEIRO-D'ALBUQUERQUE, Luiz2024-02-152024-02-152023FRONTIERS IN SURGERY, v.10, article ID 1086651, 6p, 20232296-875Xhttps://observatorio.fm.usp.br/handle/OPI/57941Background: Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats. Donor operation: We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed en bloc, flushed, and cold-stored. Recipient operation: The infrarenal aorta and vena cava were isolated and donor/ recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery. Results: We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation. Conclusion: The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.engopenAccesspelvic floor disordersfecal incontinenceurinary incontinenceintestinal transplantationtissue transplantationanal canalgender reassignmentdysphoriaautologous anorectal transplantationurinary-incontinencereassignment surgeryfecal incontinencefollow-upprevalencemodelcomplicationssymptomsimpactarticleCopyright FRONTIERS MEDIA SA10.3389/fsurg.2023.1086651Surgery