A Single-Center Clinical Experience with Fully Percutaneous, Minimally Invasive Fetoscopic Surgery for Spina Bifida...

Area of Science:

• Maternal-fetal medicine
• Minimally invasive surgery
• Neonatal outcomes

Background:

• Spina bifida aperta (SBA) management has evolved with the introduction of fetoscopic coverage in Poland.
• The 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, initiated this procedure in 2017.
• This study presents early outcomes and compares them with existing literature.

Purpose of the Study:

• To present the initial results of minimally invasive fetoscopic SBA coverage in Poland.
• To compare these outcomes with international studies on fetoscopic and open spina bifida repair.
• To evaluate maternal and neonatal outcomes following fetal surgery for SBA.

Main Methods:

• Retrospective review of 38 expectant mothers undergoing fetoscopic SBA coverage (September 2017 - February 2022).
• Procedures performed between 24-28 weeks of gestation under general materno-fetal anesthesia.
• Evolution of surgical techniques from patch to skin-to-skin suture; comparison with literature.

Main Results:

• Successful completion in 34 out of 38 attempted procedures.
• Median gestational age at surgery: 26 weeks; median delivery: 32 weeks.
• At 1-year follow-up, 41.9% of infants required a shunt; >70% had preserved or improved motor function.

Conclusions:

• Minimally invasive fetoscopic SBA surgery can be successfully implemented with a tailored curriculum.
• The fetoscopic approach allows for evaluation of diverse closure techniques.
• Preterm delivery is common but typically occurs after 30 weeks, with rare prematurity complications.