Robotic-assisted fetal myelomeningocele repair: feasibility and technique refinement using a surgical simulation
Julie Monteagudo1,2,3, Marcoandrea Giorgi4, Andrew Luhrs4
1Division of Pediatric Surgery, Department of Surgery, Brown University Health, Providence, RI, USA. Julie_Monteagudo@brown.edu.
Objectives:
To explore and refine a robotic-assisted fetal myelomeningocele (MMC) repair technique using a simulation-based platform to assess feasibility, optimize surgical strategies, and enhance training.
Methods:
A fetal simulation model was developed to support robotic practice in a fluid environment mimicking intrauterine conditions. The model included a reusable silicone fetus with a replaceable neural placode, allowing repeated simulations with minimal setup changes. Using an Intuitive® robotic surgical system, both dissection and closure techniques were performed. Each session was recorded and reviewed to evaluate instrument handling, placode manipulation, and layered closure under fetal constraints. Modifications were made iteratively to both technique and setup to improve realism and usability.
Results:
Simulations enabled refinement of robotic fetal MMC repair techniques. Procedural progress included ideal port positioning, wristed instrument angles, and strategies for minimizing placode tension during closure. The floating model provided consistent intraoperative dynamics that supported deliberate practice and technical iteration.
Conclusion:
Robotic-assisted fetal MMC repair is technically feasible and benefits from targeted simulation. This platform facilitated iterative learning, optimized workflow, and identified procedural challenges unique to fetal robotics. As robotic techniques advance, such simulation tools will be critical for training, standardization, and safe clinical translation of emerging techniques.
