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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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Irregular sleep patterns may be linked to harmful bacteria in your gut, new research suggests. The study is the first to find multiple associations between social jet lag – the shift in internal body clock when sleeping patterns change between workdays and free days – and diet quality, diet habits, inflammation and gut microbiome (bacteria) composition. According to the findings, even a 90-minute difference in the midpoint of sleep – half-way between sleep time and wake-up time – can encourage microbiome that has negative associations with health. Previous research has suggested that working shifts disrupts the body clock and can increase risk of weight gain, heart problems and diabetes. This is the first study to show that even small differences in sleep timings across the week seems to be linked to differences in gut bacterial species Dr Wendy Hall King’s College London However, according to researchers from King’s College London there is less awareness that the body’s biological rhythms can be affected by smaller inconsistencies in sleeping patterns. This is due to people working regular hours waking early with an alarm clock on workdays compared to waking naturally on non-workdays. Senior author Dr Wendy Hall from King’s College London, said: “We know that major disruptions in sleep, such as shift work, can have a profound impact on your health. “This is the first study to show that even small differences in sleep timings across the week seems to be linked to differences in gut bacterial species. “Some of these associations were linked to dietary differences but our data also indicates that other, as yet unknown, factors may be involved. “We need intervention trials to find out whether improving sleep time consistency can lead to beneficial changes in the gut microbiome and related health outcomes.” First author Kate Bermingham, from King’s College London and senior nutrition scientist at ZOE, said: “Sleep is a key pillar of health, and this research is particularly timely given the growing interest in circadian rhythms and the gut microbiome. “Even a 90-minute difference in the mid-point of sleep can encourage microbiota species which have unfavourable associations with your health.” Researchers suggest the composition of the microbes in the gut may negatively or positively affect health by producing toxins or beneficial products. Specific species of microbes can correspond to an individual’s risk of long-term health conditions such as diabetes, heart disease and obesity. The microbiome is influenced by what food someone eats, which makes the diversity of the gut adjustable. Researchers assessed a group of 934 people from the ZOE Predict study, the largest ongoing nutritional study of its kind. They looked at blood, stool and gut microbiome samples, as well as glucose measurements in people whose sleep was irregular compared to those who had a routine sleep schedule. Unlike past research, the group consisted of mainly lean and healthy individuals with most of them getting more than seven hours sleep throughout the week. The study, published in The European Journal of Nutrition, found that just a 90-minute difference in the timing of the midpoint of sleep is associated with differences in what the gut microbiome is made up of. According to the findings, having social jet lag was associated with lower overall diet quality, higher intakes of sugar-sweetened beverages, and lower intakes of fruits and nuts. This may directly influence the abundance of specific microbiota in the gut, researchers say. Three out of the six microbiota species more abundant in the social jet lag group have what researchers describe as unfavourable associations with health. They are linked with poor diet quality, indicators of obesity and cardiometabolic health, like heart attack, stroke, and diabetes, and markers in your blood related to higher levels of inflammation and cardiovascular risk. Previous research has found social jet lag is associated with weight gain, chronic illness and mental fatigue. Dr Sarah Berry from King’s College London and chief scientist at ZOE added: “Maintaining regular sleep patterns, so when we go to bed and when we wake each day, is an easily adjustable lifestyle behaviour we can all do, that may impact your health via your gut microbiome for the better.” Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live N-Dubz cement comeback with first new album in 13 years Babies as young as four months have taste in fine art, study shows ADHD symptoms in children can be transformed with brain stimulation therapy