title: Robot-assisted endoscopic intrauterine myelomeningocele repair: a feasibility study.
abstract: BACKGROUND
  Animal experiments have suggested that the intrauterine environment causes secondary injury to the congenitally dysplastic spinal cord. This in turn suggests that early closure of the myelomeningocele sac might prevent secondary injury and therefore improve neurologic outcome. This study was designed to examine the technical feasibility of performing intrauterine myelomeningocele repair using a robot-assisted endoscopic system in an animal model.
  
  
  METHODS
  Six fetal sheep underwent creation and repair of a full-thickness skin lesion using the da Vinci system.
  
  
  RESULTS
  With the device's advanced articulated instruments and three-dimensional optics, it was possible to endoscopically repair the induced skin defects.
  
  
  CONCLUSIONS
  We conclude that, with the recent evolution in robotics and minimally invasive techniques, intrauterine endoscopic surgery has become a realistic goal that promises to reduce the associated risks of fetal surgery and extend the indications for its use.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Oran S
authors.initials: OS
authors.lastname: Aaronson
authors.forename: Noel B
authors.initials: NB
authors.lastname: Tulipan
authors.forename: Robert
authors.initials: R
authors.lastname: Cywes
authors.forename: Håkan W
authors.initials: HW
authors.lastname: Sundell
authors.forename: Georges H
authors.initials: GH
authors.lastname: Davis
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Bruner
authors.forename: William O
authors.initials: WO
authors.lastname: Richards
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D021621:Imaging, Three-Dimensional; D020706:Laparoscopes; D008591:Meningomyelocele / Q000196:embryology / Q000601:surgery*; D011247:Pregnancy; D012371:Robotics / Q000295:instrumentation*; D012756:Sheep; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013536:Suture Techniques; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology