title: Intrauterine surgery--choices and limitations.
abstract: BACKGROUND
  The past decade has seen much progress in intrauterine surgery. Randomized trials have documented the benefit of some procedures of this type for the unborn child.
  
  
  METHODS
  Selective literature review
  
  
  RESULTS
  Randomized trials have demonstrated the benefit of fetoscopic laser coagulation of placental anastomoses in twin-to-twin transfusion syndrome (TTTS) and of intrauterine surgery via hysterotomy for the repair of spina bifida. Other fetoscopic procedures have yielded promising initial results but are not yet supported by findings from randomized trials. Some intrauterine surgical procedures must still be considered experimental in view of the lack of randomized trials and the rarity of the conditions they are designed to treat. Fetoscopic laser coagulation for TTTS is by far the most common procedure in fetal surgery; TTTS arises in roughly 1 in 2500 pregnancies. The other procedures discussed in this article are performed much less often and for rarer indications. In general, intrauterine surgery is indicated only to treat conditions that would otherwise lead to intrauterine death or irreversible prenatal damage.
  
  
  CONCLUSIONS
  Intrauterine surgery is a rapidly developing field. Prenatal intervention by laser coagulation is indicated to treat severe TTTS, as its benefit has been shown in a randomized trial. Not enough evidence is yet available for the possible benefit of intrauterine surgery to treat myelomeningocele and congenital diaphragmatic hernia. Other indications are experimental. When an indication for intrauterine surgery exists, the parents should be informed and, depending on their wishes, referred to a center where it can be performed.
authors.affiliation: Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Diemert
authors.forename: Werner
authors.initials: W
authors.lastname: Diehl
authors.forename: Peter
authors.initials: P
authors.lastname: Glosemeyer
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Kurt
authors.initials: K
authors.lastname: Hecher
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000601:surgery; D005332:Fetoscopy; D006801:Humans; D020883:Hysterotomy; D007231:Infant, Newborn; D017075:Laser Coagulation; D011247:Pregnancy; D016135:Spinal Dysraphism / Q000175:diagnosis / Q000601:surgery