The art of fetoscopy: a step toward minimally invasive fetal therapy
Dipika Deka1, Vatsla Dadhwal, S B Gajatheepan
1Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029 India.
Purpose:
To study the feasibility, learning curve, and safety of fetoscopy, so that fetal surgery can be confidently performed in ongoing pregnancies.
Methods:
Fetoscopy was performed at 12-20 weeks of gestation, in 12 women with fetal congenital malformations and/or for termination of pregnancy, under local anesthesia using fine fetoscopes ranging from 1 to 2-mm diameter. The fetal parts and placenta were examined for clarity of vision, identification, and anomalies.
Results:
Fetoscopy required great skill, patience, and extensive use of ultrasound for correct orientation. Visualization was better with endoscope of 2-mm diameter. Laser coagulation of placental vessels using diode laser system was possible in the last two cases. There were no major complications.
Conclusions:
Fetal endoscopy is a feasible procedure, safe in experienced hands but has an appreciable learning curve.
