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

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.