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Laparoscopic transuterine fetal vesicostomy: a feasibility study
Lee E Ponsky1, Edward E Cherullo, Kevin L W Banks
1Section of Laparoscopic and Minimally Invasive Surgery and Pediatric Urology, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. ponskyl@ccf.org
The Journal of Urology
|November 13, 2004
Summary
This study demonstrates that laparoscopic fetal vesicostomy is a feasible minimally invasive technique in pregnant ewes. Further research is needed to improve outcomes and reduce fetal loss in this surgical approach.
Area of Science:
- Veterinary Surgery
- Fetal Medicine
- Minimally Invasive Procedures
Background:
- Fetal obstructive uropathies require timely intervention.
- Traditional open fetal surgery poses significant risks.
- Minimally invasive techniques offer a promising alternative for fetal interventions.
Purpose of the Study:
- To assess the feasibility of transuterine fetal vesicostomy using minimally invasive laparoscopic techniques.
- To evaluate the efficacy and safety of this approach in a large animal model.
Main Methods:
- Twenty-five pregnant ewes underwent transuterine fetal vesicostomy via laparoscopy.
- The procedure involved creating a vesicostomy and approximating the fetal bladder to the abdominal wall.
- A 14-gauge needle was used for amniotic infusion, and balloon trocars facilitated uterine access.
Main Results:
- The technique was successfully developed and performed in 10 ewes.
- Postoperative complications included 5 abortions and 1 intrauterine fetal demise.
- Two fetuses showed successful vesicostomy healing, with one delivered at term exhibiting a strictured stoma.
Conclusions:
- Transuterine laparoscopic fetal vesicostomy is technically feasible in an ovine model.
- The procedure is technically challenging and requires further refinement.
- Future studies should focus on fetal monitoring and tocolysis to mitigate abortion rates.