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Access techniques in endoscopic fetal surgery

F I Luks¹, J A Deprest, B F Gilchrist

¹Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI, USA.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie

|June 1, 1997

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Minimal access endoscopic surgery offers a promising alternative to open fetal surgery. Techniques using radial dilatation and collagen plugs in sheep and primates demonstrate safe, minimally invasive in-utero access.

Area of Science:

Minimally Invasive Surgery
Fetal Surgery
Surgical Innovation

Background:

Open fetal surgery presents challenges and risks.
Endoscopic techniques are being explored as less invasive alternatives.
Evaluating novel access methods in animal models is crucial for clinical translation.

Purpose of the Study:

To assess the efficacy and safety of minimal access techniques for fetal surgery.
To compare different cannula insertion methods in pregnant sheep and nonhuman primates.
To evaluate techniques for achieving leak-proof closure after endoscopic procedures.

Main Methods:

Fifty-two pregnant sheep and five Rhesus monkeys were used.
Techniques included open hysterotomy with pursestring suture and Seldinger guidewire methods.

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Radially expanding cannulas and collagen sponge plugs were evaluated for access and closure.

Main Results:

Open hysterotomy with pursestring provided safe access without membrane dissection.
Seldinger technique with radial dilatation allowed secure access without membrane separation in both species.
Leak-proof cannula removal and closure were achieved in all primates.

Conclusions:

Seldinger technique with radial dilatation offers a viable, less invasive alternative to hysterotomy.
Collagen plug insertion may facilitate a truly minimally invasive approach for in-utero interventions.
These findings support the potential of endoscopic surgery for future fetal interventions.