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Surgeons worked all day and into the night to ensure Britain’s first womb transplant went smoothly. Its success is down to meticulous research, years of sharing knowledge between experts around the globe, and the hard work and dedication of doctors Professor Richard Smith, from Imperial College London, and Isabel Quiroga, from the Oxford Transplant Centre. Around 50 babies have been born worldwide as a result of womb transplants, which give women missing a functioning uterus a chance to have a baby. In the first UK case, the operation to remove the womb from the recipient’s 40-year-old sister lasted eight hours and 12 minutes, with surgeons leaving her ovaries behind to prevent pushing her into early menopause. One hour earlier, surgeons began operating on the 34-year-old recipient, preparing her body to receive the donated organ. This operation lasted nine hours and 20 minutes, with the surgical team experiencing some difficulties including a higher-than-expected blood loss of two litres. However, after just 10 days, the recipient was well enough to leave the hospital and has continued to have a good recovery. She is also having regular periods, which shows the womb is working well. Her sister was discharged five days after her donor operation and has also made a good recovery. Removing a womb is a similar operation to a radical hysterectomy, according to Prof Smith, who as well as being a gynaecological surgeon is the clinical lead at the charity Womb Transplant UK. He and Miss Quiroga led the team of more than 30 staff who worked on the transplant one Sunday in February. Prof Smith 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 doing these operations have to retrieve veins involved in the drainage of the womb. “One of the amazing things is that my surgical skill-mix as a cancer surgeon is to remove organs with a margin of normal tissue, while sealing the vessels as I go,” he said. “Transplant surgical skills are different – that is to remove a normal organ with the best number of non-sealed vessels as you can. “Isabel and I operate together with no ego – it just flows backwards and forwards across the table.” He added: “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. 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.” In the theatre next door, one hour before the retrieval of the womb was completed, surgeons began to operate on the donor’s younger sister to enable her to receive the womb. Prof Smith and Miss Quiroga switched from donor to recipient and Prof Smith removed the vestiges of the underdeveloped womb the recipient was born with. Meanwhile, the organ was packed and transported between the two theatres under sterile conditions to prevent contamination. A sterile bag with a cold perfusion solution contained the womb, which was then placed into a container with ice. During surgery, ligaments attached to the womb were attached to the recipient to help the womb 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. 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. Prof Smith said: “We know that the chance of failure at the point where the uterus goes in – if you look at the world literature – is 20 per cent to 25 per cent. And that failure is usually on the basis on 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 per cent. “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. 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 still a long way off. He said the pelvic anatomy, vascular anatomy and shape of the pelvis are different, and there are microbiome issues to overcome. “My own sense is if there are transgender transplants that are going to take place, they are many years off. There are an awful lot of steps to go through. My suspicion is a minimum of 10 to 20 years.” 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. 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A new immigration law passed by Florida governor Ron DeSantis, described by observers as one of the harshest in the country, has caused a massive decline in the Sunshine State’s labour force since it took effect, according to some business owners. The Republican leader and 2024 presidential campaign’s signature immigration law, which took effect 1 July, makes it a third-degree felony for unauthorised immigrants to knowingly use false ID’s for employment, and business that knowingly employ unauthorised immigrants or who avoid using the E-Verify system can lose their licenses or face up to $1000 in fines. The law also requires hospitals that accept Medicaid to check for immigration status, and invalidates drivers licenses issued to unauthorised immigrants from other states. In Miami’s booming construction industry, some companies are reporpting up to a 25 per cent decline in workers, The Wall Street Joural reports. “We’ve seen some fallout on job sites, particularly as it relates to hourly labor as a result of this new law,” Tom C Murphy, co-president of Coastal Construction, a company with more than 30 active projects across the state, told the paper. There at least 400,000 undocumented immigrants working in the state, according to Samuel Vilchez Santiago, the American Business Immigration Coalition’s Florida director. “We are in dire need of workers,” he told the Associated Press last month. “So there is a lot of fear from across the state ... that this new law will actually be devastating.” Migrant groups protested the new law in June, while the governor’s office told the AP in a statement, “Any business that exploits this crisis by employing illegal aliens instead of Floridians will be held accountable.” Mr DeSantis, despite governing a state known for its vibrant immigrant populations from Latin America, has positioned himself as a hard-line anti-immigrant crusader as he runs for president. In late June, he visited the US-Mexico border, where he blamed security issues on the Biden administration and proposed a return to most of Donald Trump’s most controversial immigration policies. That includes detaining migrant families with children beyond the customary 20 days, finishing the US-Mexico border wall, and ending the long-standing practice of releasing migrants into the US ahead of their court dates on potential immigration charges, which are usually civil violations rather than criminal ones more typically associated with prison. Read More Pete Buttigieg takes down Ron DeSantis over ‘strange’ anti-LGBT campaign video with ‘oiled-up bodybuilders’ 'Parental rights' group Moms for Liberty plans nationwide strategy for school board races in 2024 Florida's new DeSantis-backed laws address immigration, guns and more Giuliani grilled by prosecutors about ‘shouting match’ in fight to overturn election Former sheriff who nabbed 'Green River Killer' to run for Washington governor Senegalese President Macky Sall says he won't seek a third term in 2024 elections after protests

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