A model for fetal surgery through intrauterine endoscopy

Area of Science:

• Veterinary Surgery
• Minimally Invasive Procedures
• Fetal Medicine

Background:

• Fetal surgery holds potential for treating congenital anomalies.
• Minimally invasive techniques are needed to reduce fetal risks.
• Existing endoscopic methods require adaptation for intrauterine fetal procedures.

Purpose of the Study:

• To develop and evaluate a model for intrauterine fetal surgery using video-endoscopic technology in pregnant ewes.
• To assess the feasibility and safety of endoscopic surgical procedures in the fetal lamb model.
• To establish continuous monitoring of fetal physiological parameters during intrauterine surgery.

Main Methods:

• Developed specialized 5-mm endoscopic ports inserted via hysterotomy into pregnant ewes (95-105 days gestation).
• Utilized amnioinfusion with warmed physiological fluid as the operative medium.
• Performed procedures including abdominal wall dissection, urethral ligation, urachal ligation, and organ endoscopy, with continuous fetal monitoring (heart rate, oxygen saturation, temperature, amniotic pressure).
• Employed a novel bipolar coagulation device for bloodless dissection in an electrolyte-rich medium.

Main Results:

• Successfully performed various intrauterine endoscopic surgeries on fetal lambs, with mean operative times of 147 minutes.
• Maintained stable intra-amniotic temperatures (38.0-41.7°C) and monitored fetal oxygen saturation (51-72%) and heart rate (120-140 bpm).
• Achieved bloodless surgical field using the novel coagulation device.

Conclusions:

• Intrauterine endoscopy in a fluid medium is a viable method for performing lengthy, monitored fetal surgical procedures.
• This model demonstrates the potential of video-endoscopic technology for advancing fetal surgery.
• Continuous physiological monitoring is achievable during intrauterine endoscopic interventions in fetal lambs.