title: Fetal surgery is a clinical reality.
abstract: An increasing number of fetal anomalies are being diagnosed prior to birth, some of them amenable to fetal surgical intervention. We discuss the current clinical status and recent advances in endoscopic and open surgical interventions. In Europe, fetoscopic interventions are widely embraced, whereas the uptake of open fetal surgery is much less. The indications for each access modality are different, hence they cannot substitute each other. Although the stage of technical experimentation is over, most interventions remain investigational. Today there is level I evidence that fetoscopic laser surgery for twin-to-twin transfusion syndrome is the preferred therapy, but this operation actually takes place on the placenta. In terms of surgery on the fetus, an increasingly frequent indication is severe congenital diaphragmatic hernia as well as myelomeningocele. Overall maternal safety is high, but rupture of the membranes and preterm delivery remain a problem. The increasing application of fetal surgery and its mediagenicity has triggered the interest to embark on fetal surgical therapy, although the complexity as well as the overall rare indications are a limitation to sufficient experience on an individual basis. We plead for increased exchange between high volume units and collaborative studies; there may also be a case for self-regulation. Inclusion of patients into trials whenever possible should be encouraged rather than building up casuistic experience.
authors.affiliation: Division Woman and Child, University Hospital Gasthuisberg, Leuven, Belgium. jan.deprest@uzleuven.be
authors.forename: Jan A
authors.initials: JA
authors.lastname: Deprest
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.forename: Kasemsri
authors.initials: K
authors.lastname: Srisupundit
authors.forename: Veronika
authors.initials: V
authors.lastname: Beck
authors.forename: Inga
authors.initials: I
authors.lastname: Sandaite
authors.forename: Silvia
authors.initials: S
authors.lastname: Rusconi
authors.forename: Filip
authors.initials: F
authors.lastname: Claus
authors.forename: Gunnar
authors.initials: G
authors.lastname: Naulaers
authors.forename: Marc
authors.initials: M
authors.lastname: Van de Velde
authors.forename: Paul
authors.initials: P
authors.lastname: Brady
authors.forename: Koen
authors.initials: K
authors.lastname: Devriendt
authors.forename: Joris
authors.initials: J
authors.lastname: Vermeesch
authors.forename: Jaan
authors.initials: J
authors.lastname: Toelen
authors.forename: Marianne
authors.initials: M
authors.lastname: Carlon
authors.forename: Zeger
authors.initials: Z
authors.lastname: Debyser
authors.forename: Luc
authors.initials: L
authors.lastname: De Catte
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002986:Clinical Trials as Topic; D000013:Congenital Abnormalities / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000601:surgery; D005332:Fetoscopy / Q000379:methods* / Q000592:standards; D005333:Fetus / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D053685:Laser Therapy; D008591:Meningomyelocele / Q000601:surgery; D010920:Placenta / Q000601:surgery; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D014430:Twins, Monozygotic