title: Modification of the gasless fetoscopy technique for the treatment of large myelomeningocele: a study in sheep.
abstract: OBJECTIVE
  To change the gasless fetoscopy technique in order to reduce the diameter of entry orifices in the myometrium.
  
  
  METHODS
  Seven pregnant ewes were submitted to fetoscopy for repairing a large skin defect measuring 4.0 × 3.0 cm, created in the fetal lumbar region at the gestational age of 100 days. The defect was repaired through continuous suture of the skin with approximation of borders. Gasless fetoscopy was used for performing the suture with three orifices to allow entry of the trocar into the myometrium. A 5.0-mm optical trocar, and 3.5-mm grasping, dissecting and suturing forceps were used. After surgery, pregnancy was maintained until the animals were euthanized on the 133rd day of gestation, and the fetuses were evaluated.
  
  
  RESULTS
  Seven pregnant ewes underwent surgery; the first two cases were characterized as the Pilot Group, in which the endoscopic technique was modified and caliber reduction was possible in two out of three entry orifices in the myometrium. In the five remaining cases (Study Group), the repair was successfully carried out in all the fetuses, and the mean duration of fetoscopy was 98 minutes. There was a case of maternal death attributed to intrauterine infection. Mean intrauterine permanence after surgery was 12 days.
  
  
  CONCLUSIONS
  The technique was successfully modified, allowing reduction of the uterine orifices necessary to perform the repair of a skin defect in the fetal lumbar region through a new fetoscopy technique. The impact of this modification in repair of myelomeningocele in human fetuses should be studied.
authors.affiliation: Department of Pathology of Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil.
authors.forename: Denise Araujo Lapa
authors.initials: DA
authors.lastname: Pedreira
authors.affiliation: Department of Obstetrics of Faculdade de Medicina, Universidade de Taubaté - UNITAU, São Paulo, SP, Brazil.
authors.forename: Gregório Lorenzo
authors.initials: GL
authors.lastname: Acácio
authors.affiliation: aff3, Brazil.
authors.forename: Rogério Chaccur
authors.initials: RC
authors.lastname: Abou-Jamra
authors.affiliation: Department of Pathology of Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil.
authors.forename: Rita de Cássia Sanches
authors.initials: Rde C
authors.lastname: Oliveira
authors.affiliation: Department of Pathology of Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil.
authors.forename: Elia Garcia
authors.initials: EG
authors.lastname: Caldini
authors.affiliation: Department of Pathology of Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil.
authors.forename: Paulo Hilário Nascimento
authors.initials: PH
authors.lastname: Saldiva