Operative fetoscopy: new perspective in fetal therapy?

Area of Science:

• Medical Science
• Surgical Innovation
• Fetal Medicine

Background:

• Open fetal surgery can be life-saving for conditions like congenital diaphragmatic hernia but carries risks of premature labor and invasiveness.
• Fetoscopy, merging fetoscopy with advanced video-endoscopic surgery, represents a less invasive approach to fetal interventions.
• Animal models have been developed to assess the safety and feasibility of endoscopic fetal surgery.

Purpose of the Study:

• To evaluate the potential of endoscopic fetal surgery ('fetendo' surgery).
• To compare the invasiveness of endoscopic versus open fetal surgery.
• To assess the efficacy and safety of fetoscopic interventions for specific fetal conditions.

Main Methods:

• Development of animal models to test endoscopic surgical techniques on fetuses.
• Comparison of uterine activity between endoscopic and open surgical approaches in non-human primates.
• Application of fetoscopy for treating complicated monochorionic twin gestations, including laser coagulation and cord ligation.

Main Results:

• Endoscopic fetal surgery demonstrated significantly less uterine activity compared to open hysterotomy in non-human primates.
• Fetoscopic laser coagulation for severe feto-fetal transfusion syndrome shows approximately 55% survival with 5% neurological morbidity.
• Fetoscopic cord ligation offers a 66% survival rate but carries a 30% risk of preterm pre-labor rupture of membranes (PPROM) before 32 weeks.

Conclusions:

• Endoscopic fetal surgery presents a promising, less invasive option for fetal therapy, despite being in its early experimental stages.
• Formal guidelines, similar to those for open fetal surgery, should be followed for the development of endoscopic fetal surgery.
• Prospective registration of global experience and randomized trials are recommended to further validate endoscopic fetal surgery techniques.