Percutaneous fetoscopic patch coverage of experimental lumbosacral full-thickness skin lesions in sheep.
BACKGROUND
In order to minimize maternal trauma from open fetal surgery for prenatal coverage of fetal myelomeningoceles in humans, we assessed the feasibility of a percutaneous fetoscopic approach in sheep.


METHODS
In seven ewes between 90 and 100 days of gestation, the amniotic cavity was entered percutaneously. Each fetus was postured and a full-thickness skin lesion was created in the lumbosacral region. Then, the feasibility of covering this lesion with a patch and fetal skin by standard endoscopic suturing techniques (n = 3) or robot assistance (n = 4) was assessed.


RESULTS
Percutaneous fetoscopic patch and skin coverage of the full-thickness skin lesion was achieved in six of the seven fetal sheep. Five fetuses survived gestation and were delivered healthy.


CONCLUSIONS
Percutaneous fetoscopic posturing and patch coverage of lumbosacral full-thickness skin lesions can effectively and safely be achieved in sheep. This approach promises to provide a substantial reduction of maternal trauma from fetal surgery for myelomeningoceles.
Department of Obstetrics and Prenatal Medicine, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany. thokohl@t-online.de
T
T
Kohl
M G
MG
Hartlage
D
D
Kiehitz
M
M
Westphal
T
T
Buller
S
S
Achenbach
S
S
Aryee
U
U
Gembruch
A
A
Brentrup
D000818:Animals; D003094:Collagen; D005240:Feasibility Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005332:Fetoscopy / Q000379:methods*; D007022:Hypotension / Q000209:etiology; D008161:Lumbosacral Region / Q000601:surgery*; D008591:Meningomyelocele / Q000601:surgery; D023421:Models, Animal; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control; D019736:Prostheses and Implants; D012371:Robotics; D012756:Sheep; D016135:Spinal Dysraphism / Q000601:surgery; D013536:Suture Techniques
D011138:Polytetrafluoroethylene; D003094:Collagen