Two new approaches in intrauterine tracheal occlusion using an ultrathin fetoscope.
OBJECTIVE
To introduce and establish a new approach in minimal invasive fetoscopic surgery in order to reduce access trauma and the iatrogenic preterm premature rupture of the membranes (PPROM) as a major complication of intrauterine treatment of congenital diaphragmatic hernia.


METHODS
In total, 27 pregnant sheep were operated on using fetoscopes with 1.2 and 1.0 mm optics. We used an elliptic sheath alone with a maximum diameter of 2.6/1.3 mm; in these cases the balloon was placed under ultrasound control. In comparison, we placed the balloon under fetoscopic control using the fetoscopic sheath and a 7F (2.3 mm) introducer. Therefore, the maximum access trauma was not bigger than the diameter of sheath of introducer.


RESULTS
With this technique we successfully operated on 22 sheep. The use of real time three-dimensional ultrasound control distinctly facilitates the operation procedure.


CONCLUSIONS
Our preliminary findings show that fetoscopic tracheal occlusion using ultrathin fetoscopes and reducing the access trauma on the level of 4.2 or even 2.65 mm(2) could be seen as a method of reducing the rate of PPROM.
Tchirikov
Michael
M
Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany. tchirikov@uni-mainz.de
Gatopoulos
Georgios
G
Strohner
Miriam
M
Puhl
Alexander
A
Steetskamp
Joscha
J
D000818:Animals; D021721:Balloon Occlusion / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000517:prevention & control; D020669:Fetoscopes; D005332:Fetoscopy / Q000009:adverse effects / Q000379:methods*; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D011247:Pregnancy; D012756:Sheep; D014132:Trachea