title: Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos).
abstract: BACKGROUND
  Despite advances in the development of fetal surgery, morbidity and mortality are substantial. A natural orifice transluminal endoscopic surgery (NOTES)-guided approach to the gravid uterus may offer a less-invasive technique.
  
  
  OBJECTIVE
  To assess the feasibility of NOTES for diagnostic and therapeutic intrauterine fetal interventions.
  
  
  METHODS
  Survival and nonsurvival experiments on pregnant sheep.
  
  
  METHODS
  Nonsurvival experiments performed in 2 pregnant sheep (80-110 days' gestation). A third ewe underwent NOTES and survived for 4 weeks. Transgastric (nonsurvival ewes) and transvaginal (1 nonsurvival and the survived ewe) peritoneoscopy was performed after standard needle-knife entry into the peritoneal cavity. Endoscopic access to the gravid uterus was assessed. EUS-guided, transuterine injection of saline solution into the fetal cardiac ventricle and vessels was attempted in all.
  
  
  METHODS
  Feasibility of NOTES- and EUS-guided intervention in a pregnant animal model, visibility of fetal parts via EUS compared with transabdominal US.
  
  
  RESULTS
  Entry into the peritoneal cavity was achieved in each ewe. Access to and complete visualization of the gravid uterus were successful once within the abdominal cavity. Visualization of the fetal parts and the placental cotyledons by EUS was achieved in all animals. EUS-guided amniocenteses and transuterine intracardiac and intravascular injection of saline were successful. There were no complications or preterm delivery after the procedures.
  
  
  CONCLUSIONS
  Animal model.
  
  
  CONCLUSIONS
  NOTES is technically feasible in the pregnant ewe. Intraperitoneal EUS via a NOTES approach provides excellent access and visualization of the intrauterine cavity and fetal parts.
authors.affiliation: Medicine/Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. sgiday1@jhmi.edu
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Giday
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Buscaglia
authors.forename: Janyne
authors.initials: J
authors.lastname: Althaus
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.forename: Devi M
authors.initials: DM
authors.lastname: Krishnamurty
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
authors.forename: Dawn
authors.initials: D
authors.lastname: Ruben
authors.forename: David
authors.initials: D
authors.lastname: Liang
authors.forename: Ronald
authors.initials: R
authors.lastname: Wroblewski
authors.forename: Priscilla
authors.initials: P
authors.lastname: Magno
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D005333:Fetus / Q000601:surgery*; D011247:Pregnancy; D012756:Sheep; D014741:Video Recording