Fetal surgery: principles, indications, and evidence

Area of Science:

• Medical Science
• Surgical Innovation
• Fetal Medicine

Background:

• Fetal surgery has evolved since 1965, with improved techniques enhancing outcomes for numerous fetal conditions.
• Established indications for antenatal surgery include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, tracheal obstruction, and specific tumors.

Purpose of the Study:

• To review the evolution and current status of fetal surgery.
• To highlight the shift towards evidence-based antenatal interventions through prospective trials.
• To identify persistent challenges and the multidisciplinary team approach required for fetal interventions.

Main Methods:

• Review of historical data and case series in fetal surgery.
• Analysis of outcomes from prospective randomized trials and ongoing studies.
• Examination of challenges in patient selection, timing, and prevention of preterm birth.

Main Results:

• Fetal surgical procedures have demonstrated significant improvements in outcomes for many conditions.
• Prospective randomized trials are increasingly supporting an evidence-based approach to antenatal intervention.
• Challenges remain in identifying ideal candidates, optimal timing, and preventing preterm birth.

Conclusions:

• Fetal surgery has made substantial progress, but challenges in optimal application persist.
• An evidence-based approach is crucial for refining antenatal interventions.
• Comprehensive multidisciplinary and psychosocial support is essential for families undergoing fetal surgery.