title: Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation.
abstract: Today, modern ultrasound equipment and the wide implementation of screening programmes allow the timely diagnosis of many congenital anomalies. For some of these, fetal surgery may be a life-saving option. In Europe, open fetal surgery became poorly accepted because of its invasiveness and the high incidence of postoperative premature labour and rupture of the fetal membranes. In the 1990s, the merger of fetoscopy and advanced video-endoscopic surgery formed the basis for endoscopic fetal surgery. We review the current applications of fetal surgery via both methods of access. The first clinical fetoscopic surgeries were interventions on the umbilical cord and the placenta, often referred to as obstetrical endoscopy. The outcome of a randomized clinical trial demonstrating that fetoscopic laser coagulation of chorionic plate vessels is the most effective treatment for twin-twin transfusion syndrome (TTTS) has revived interest in endoscopic fetal therapy. Operating on the fetus is another more challenging enterprise. Clinical fetal surgery programmes were virtually non-existent in Europe until minimally invasive fetoscopic surgery made such operations clinically possible as well as maternally acceptable. At present, most experience has been gathered with fetal tracheal occlusion as a therapy for severe congenital diaphragmatic hernia. As in other fields, minimally invasive surgery has pushed back boundaries and now allows safe operations to be performed on the fetal patient. Whereas minimal access seems to solve the problem of preterm labour, all procedures remain invasive, and carry a risk to the mother and a substantial risk of preterm prelabour rupture of the membranes (PPROM). The latter problem may prove to be a bottleneck for further developments, although treatment modalities are currently being evaluated.
authors.affiliation: Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospital Leuven, 3000 Leuven, Belgium. jan.deprest@uz.kuleuven.ac.be
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Jacques
authors.initials: J
authors.lastname: Jani
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.forename: Nicole
authors.initials: N
authors.lastname: Ochsenbein-Kölble
authors.forename: Mieke
authors.initials: M
authors.lastname: Cannie
authors.forename: Elisa
authors.initials: E
authors.lastname: Doné
authors.forename: Xenia
authors.initials: X
authors.lastname: Roubliova
authors.forename: Tim
authors.initials: T
authors.lastname: Van Mieghem
authors.forename: Anne
authors.initials: A
authors.lastname: Debeer
authors.forename: Frederik
authors.initials: F
authors.lastname: Debuck
authors.forename: Laurenço
authors.initials: L
authors.lastname: Sbragia
authors.forename: Jaan
authors.initials: J
authors.lastname: Toelen
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.forename: Paul
authors.initials: P
authors.lastname: Lewi
authors.forename: Marc
authors.initials: M
authors.lastname: Van de Velde
mesh_terms: D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000601:surgery; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000601:surgery; D005332:Fetoscopy / Q000379:methods*; D005333:Fetus / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D008591:Meningomyelocele / Q000601:surgery; D011247:Pregnancy; D014427:Twins