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Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators

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Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program.

Jena L Miller¹, Mari L Groves², Edward S Ahn³

¹The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA.

Fetal Diagnosis and Therapy

|September 14, 2021

Summary

This study shows that a laparotomy-assisted 2-port fetoscopic technique for prenatal spina bifida closure is feasible and safe, with good outcomes for both mother and baby. This minimally invasive approach offers a promising alternative to open fetal surgery.

Keywords:

3D printing Fetal surgery Fetoscopy Myelomeningocele Partial carbon dioxide insufflation Patient-matched model Simulation Surgical rehearsal

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Area of Science:

Minimally Invasive Surgery
Fetal Surgery
Neonatal Neurology

Background:

Open fetal surgery for spina bifida improves infant neurologic outcomes but involves significant maternal morbidity.
Minimally invasive fetoscopic techniques aim for similar fetal benefits with reduced maternal risks.
The optimal fetoscopic technique for prenatal spina bifida repair remains under investigation.

Purpose of the Study:

To describe the development, evolution, and feasibility of a novel laparotomy-assisted 2-port fetoscopic technique for prenatal spina bifida closure.
To evaluate the safety and efficacy of this technique in a newly established program.

Main Methods:

A retrospective cohort study of women undergoing laparotomy-assisted 2-port fetoscopy for isolated fetal spina bifida.
Inclusion/exclusion criteria mirrored the Management of Myelomeningocele Study (MOMS).
Extensive team preparation, including simulation, preceded program implementation.

Main Results:

Fetoscopic closure was successfully completed in 84% of cases.
Technique evolved to a multilayer closure, improving outcomes.
Significant improvement in hindbrain herniation was observed in 86% of fetuses.
Favorable maternal and perinatal outcomes included a median gestational age of 37 weeks at birth and 56% vaginal births.

Conclusions:

A laparotomy-assisted 2-port fetoscopic spina bifida closure program, supported by rigorous preparation and multidisciplinary training, can accelerate the learning curve.
This technique demonstrates favorable obstetric and perinatal outcomes, offering a viable alternative to open fetal surgery.