[Endocopic fetal surgery]

Area of Science:

• Medical Science
• Surgical Innovation
• Fetal Medicine

Context:

• The fetus is increasingly recognized as a patient capable of developing life-threatening conditions.
• Current therapeutic options for fetal diseases are limited, with fetal surgery being a primary intervention.
• Endoscopic fetal surgery has emerged as a key technique for managing various lethal fetal pathologies.

Purpose:

• To review the current landscape and advancements in endoscopic fetal surgery.
• To highlight the efficacy of specific fetal surgical techniques in improving outcomes for complex fetal conditions.
• To underscore the potential of minimally invasive fetal interventions.

Summary:

• Laser therapy and cord occlusion for twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (IUGR) achieve 80-90% survival for at least one twin.
• Fetal endoscopic tracheal occlusion (FETO) dramatically increases survival for congenital diaphragmatic hernia (CDH), improving rates from 5% to 55% (left CDH) and 1% to 33% (right CDH), while reducing pulmonary hypertension.
• Fetal cystoscopy aids in diagnosing and treating lower urinary tract obstruction (LUTO), and fetal bronchoscopy addresses pulmonary masses by relieving airway obstruction.

Impact:

• These fetal surgical interventions significantly enhance survival rates for conditions previously considered fatal.
• Minimally invasive techniques reduce neonatal morbidity and preserve vital organ function, improving long-term outcomes.
• Advancements in fetal surgery offer new hope and therapeutic avenues for complex congenital anomalies.