Endoscopic excision and repair of simulated bilateral cleft lips in fetal lambs

The use of nonpenetrating clips to accomplish wound closure as an alternative to suture in the repair of simulated cleft lips in partially exteriorized fetuses has been described previously. In this study, the fetus is approached endoscopically, and clipped (n = 8) and sutured (n = 4) intrauterine endoscopic repairs in six lambs (90- to 95-day gestation) are compared. Also used was a newly developed harmonic scalpel to create the defects in the fluid environment. Clipped repairs were nearly 10 times faster than sutured repairs (2.7 +/- 0.5 minutes compared with 24 +/- 4 minutes, respectively). Furthermore, suture incited foreign body inflammation, recruited monocytic inflammatory cells, and exhibited notable scarring. The comparison between clipped and sutured repairs extends the previous observations to the realm of endoscopy and reinforces the previous conclusions of this group that the nonpenetrating clip is more rapid and incites less inflammation than suture in fetal wound approximation and repair.