Fetal surgery is a clinical reality.
Jan A Deprest1, Roland Devlieger, Kasemsri Srisupundit
1Division Woman and Child, University Hospital Gasthuisberg, Leuven, Belgium. jan.deprest@uzleuven.be
Seminars in Fetal & Neonatal Medicine
|November 17, 2009
Summary
Fetal surgery, including endoscopic and open procedures, is advancing for prenatal diagnoses. While fetoscopic laser surgery for twin-to-twin transfusion syndrome is evidence-based, complex fetal surgeries like congenital diaphragmatic hernia require more collaborative research.
Area of Science:
- Medical Science
- Surgical Innovation
- Prenatal Diagnosis
Background:
- Fetal anomalies are increasingly diagnosed prenatally.
- Some anomalies are treatable with fetal surgical interventions.
- Fetoscopic interventions are more common in Europe than open fetal surgery.
Purpose of the Study:
- To review the current clinical status of fetal surgical interventions.
- To discuss recent advances in endoscopic and open fetal surgery.
- To highlight the distinct indications for different surgical approaches.
Main Methods:
- Review of current clinical status and recent advances in fetal surgery.
- Discussion of endoscopic and open surgical techniques.
- Analysis of evidence for specific fetal interventions.
Main Results:
- Fetoscopic laser surgery for twin-to-twin transfusion syndrome has level I evidence as preferred therapy.
- Severe congenital diaphragmatic hernia and myelomeningocele are increasing indications for fetal surgery.
- Maternal safety is generally high, but membrane rupture and preterm delivery are complications.
Conclusions:
- Most fetal interventions remain investigational despite technical advancements.
- Increased collaboration and data sharing among high-volume centers are crucial.
- Patient enrollment in clinical trials is encouraged over isolated case experience.
