title: Percutaneous fetoscopic laser decompression of congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia via a single trocar--current technical constraints and potential solutions for future interventions.
abstract: OBJECTIVE
  To alleviate congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia by percutaneous minimally-invasive fetoscopic tracheal decompression using laser.
  
  
  METHODS
  The procedure was performed via one trocar under general maternofetal anesthesia in a human fetus with CHAOS from laryngeal atresia at 21+6 weeks of gestation.
  
  
  RESULTS
  Normalization of the lung-heart size relationship was observed within days after the procedure. The fetus was delivered by ex utero intrapartum treatment (EXIT) in order to perform a tracheotomy at 31+1 weeks of gestation and survived hospital treatment to discharge.
  
  
  CONCLUSIONS
  Percutaneous minimally-invasive fetoscopic decompression of the fetal trachea via a single trocar is feasible in human fetuses with CHAOS from laryngeal atresia.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, German Center for Fetal Surgery and Minimally-Invasive Therapy, Bonn, Germany. thomas.kohl@ukb.uni-bonn.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohl
authors.forename: Patricia
authors.initials: P
authors.lastname: Van de Vondel
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Stressig
authors.forename: Hans C
authors.initials: HC
authors.lastname: Wartenberg
authors.forename: Axel
authors.initials: A
authors.lastname: Heep
authors.forename: Sabine
authors.initials: S
authors.lastname: Keiner
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Axel
authors.initials: A
authors.lastname: Franz
authors.forename: Susanne
authors.initials: S
authors.lastname: Fröhlich
authors.forename: Winfried
authors.initials: W
authors.lastname: Willinek
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000151:congenital / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000209:etiology / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods; D005333:Fetus / Q000601:surgery; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications* / Q000601:surgery; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D011247:Pregnancy; D013525:Surgical Instruments; D013577:Syndrome; D014132:Trachea / Q000000981:diagnostic imaging / Q000601:surgery*; D016216:Ultrasonography, Prenatal