title: Treatment of a Fetal Tracheal Obstruction by Fetoscopy and Laser.
abstract: We report below a case of in utero tracheoscopy with laser collapse of a bronchogenic cyst obstructing the fetal trachea. The patient was referred for ultrasonography at 24 weeks of gestation because of fetal hydrops. Tracheoscopy was performed via fetoscopic approach using a single trocar under local anesthesia with lidocaine and ultrasound guidance. This revealed an image suggestive of a cyst obstructing the middle third at the anterior base of the trachea. Coagulation using a diode laser enabled us to collapse this fluid-filled cyst with three 10-watt bursts (3 times 3 s) and to visualize a completely unobstructed tracheobronchial tree with significant pulmonary fluid reflux on removal of the obstacle. The fetal condition improved markedly within 48 h after the procedure. To the best of our knowledge, this is the first described case of in utero treatment of a tracheal obstruction by tracheoscopy and laser. In severe cases of obstruction of the fetal airways, whether the obstacle is situated in a high or low position, fetal endoscopy is of diagnostic and potentially therapeutic utility.
authors: Department of Obstetrics and Gynecology, Strasbourg University Teaching Hospital, Strasbourg, France.
authors: Sandra
authors: S
authors: Bel
authors: Nicolas
authors: N
authors: Sananes
authors: Adrien
authors: A
authors: Gaudineau
authors: Cherif
authors: C
authors: Akladios
authors: Romain
authors: R
authors: Favre
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D005260:Female; D005332:Fetoscopy; D006801:Humans; D008476:Mediastinal Cyst / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal