Radial Expansion of Chorioamniotic Membranes After Perforation Causes Less Damage Than Fixed Diameter Instruments

Area of Science:

• Fetal surgery
• Membrane perforation
• Surgical innovation

Background:

• Iatrogenic preterm premature rupture of membranes (iPPROM) is a significant complication in fetoscopic surgeries, occurring in up to 40% of cases.
• The chorioamniotic membrane has limited healing capacity after surgical perforation, contributing to iPPROM.
• Radial expansion techniques, successful in other surgical fields, have not been explored for fetal surgery.

Purpose of the Study:

• To investigate the efficacy of radial expansion technology in minimizing damage to the chorioamniotic membrane during fetal surgery.
• To compare the perforation characteristics created by radial expansion devices versus traditional trocars.

Main Methods:

• Fresh chorioamniotic membranes were perforated using a 2 mm (6Fr) trocar, a 4 mm (12Fr) trocar, and a radially expanding angioplasty balloon (2-4 mm).
• Perforation dimensions (height, width, area) and shape regularity were quantitatively analyzed.

Main Results:

• The angioplasty balloon created perforations with an area similar to the 2 mm trocar and significantly smaller than the 4 mm trocar.
• Radial expansion resulted in more regularly shaped perforations (circular/elliptical) compared to the irregular defects caused by the 12Fr trocar.

Conclusions:

• Radial expansion technology effectively minimizes chorioamniotic membrane damage and promotes more regular perforation shapes after fetal surgery.
• This approach holds promise as a strategy to reduce the incidence of iatrogenic preterm premature rupture of membranes (iPPROM) in fetal therapy.