title: Fetoscopic single-layer repair of open spina bifida using a cellulose patch: preliminary clinical experience.
abstract: OBJECTIVE
  To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique.
  
  
  METHODS
  Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch.
  
  
  RESULTS
  Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases.
  
  
  CONCLUSIONS
  Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.
authors.affiliation: Pathology Department, University of São Paulo , São Paulo , Brazil .
authors.forename: Denise A L
authors.initials: DA
authors.lastname: Pedreira
authors.forename: Nelci
authors.initials: N
authors.lastname: Zanon
authors.forename: Renato A M
authors.initials: RA
authors.lastname: de Sá
authors.forename: Gregório L
authors.initials: GL
authors.lastname: Acacio
authors.forename: Edilson
authors.initials: E
authors.lastname: Ogeda
authors.forename: Teresa M L O U
authors.initials: TM
authors.lastname: Belem
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
authors.forename: Eftichia
authors.initials: E
authors.lastname: Kontopoulos
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Quintero
mesh_terms: D000328:Adult; D002482:Cellulose; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D016137:Spina Bifida Cystica / Q000601:surgery*; D013536:Suture Techniques
chemical_list: D002482:Cellulose
keywords: Cellulose; fetal therapy; fetoscopy; meningomyelocele; myelomeningocele; spina bifida