Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions

Kohl, Thomas; Hering, R.; Vondel, P. Van de; Tchatcheva, K.; Berg, Christoph; Bartmann, Peter; Heep, Axel; Franz, Axel; Müller, Andreas; Gembruch, Ulrich

doi:10.1007/s00464-005-0662-z

Cited by 30 publications

(25 citation statements)

References 20 publications

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“…As with intrauterine prenatal diagnostic procedures like amniocentesis, chorion villus sampling, cord blood sampling, intrauterine fetal blood transfusion and shunts, the procedure of fetoscopy ethically should be ''learnt''; expertise and confidence gained-first by observation and then by performing the procedure in MTP cases; and not training directly on ongoing pregnancies, thereby putting the pregnancy and fetus in jeopardy. Studies are going on with regard to the appropriate operating timing, standardization of selection criteria, and multicenter randomized trials are also ongoing to define whether fetal surgery is associated with better outcomes as compared with postnatal treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

Deka

Dadhwal

Gajatheepan

et al. 2012

J Obstet Gynecol India

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Purpose To study the feasibility, learning curve, and safety of fetoscopy, so that fetal surgery can be confidently performed in ongoing pregnancies. Methods Fetoscopy was performed at 12-20 weeks of gestation, in 12 women with fetal congenital malformations and/or for termination of pregnancy, under local anesthesia using fine fetoscopes ranging from 1 to 2-mm diameter. The fetal parts and placenta were examined for clarity of vision, identification, and anomalies. Results Fetoscopy required great skill, patience, and extensive use of ultrasound for correct orientation. Visualization was better with endoscope of 2-mm diameter. Laser coagulation of placental vessels using diode laser system was possible in the last two cases. There were no major complications. Conclusions Fetal endoscopy is a feasible procedure, safe in experienced hands but has an appreciable learning curve.

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Section: Introductionmentioning

confidence: 99%

The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

Deka

Dadhwal

Gajatheepan

et al. 2012

J Obstet Gynecol India

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“…Trochars are placed into the amniotic cavity using a Seldinger approach and a flexible fetoscope introduced into the amniotic cavity (25,26). Balloon tipped trochars can be used to minimize damage to the uterine wall and membranes (27). Following conclusion of the procedure, the uterine access sites and the maternal abdominal trochar sites are closed.…”

Section: Fetoscopic Surgerymentioning

confidence: 99%

Advances in fetal surgery

Maselli¹,

Badillo²

2016

Ann. Transl. Med.

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Historically, the gold standard for the treatment of congenital malformations has been planned delivery at tertiary care center with attempted post-natal repair or amelioration of the lesion. Over the last few decades however, rapid advances in imaging and instrumentation technology combined with superior knowledge of fetal pathophysiology has led to the development of novel intrauterine interventions for most common fetal anomalies.Great success has already been seen the treatment of previous devastating anomalies such as myelomeningocele (MMC), congenital cystic malformations of the lung, twin-twin transfusion, and sacrococcygeal teratomas.Although still limited, these innovative techniques have unique potential to improve outcomes in the most devastating fetal anomalies.

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“…16 However, centres that have performed very complex interventions using CO 2 for placental surgery did not report fetal adverse effects. [17][18][19] …”

Section: Distension Mediummentioning

confidence: 99%

Instrumental requirements for minimal invasive fetal surgery

Klaritsch

Albert

Mieghem

et al. 2008

BJOG

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Minimal invasive intrauterine interventions have gained their place in fetal medicine. Interventions on the placenta, umbilical cord, fetal membranes or on the fetus require special endoscopes with their respective sheaths, cannulas and additional instruments. Instruments for fetal therapy are purpose designed for the procedure of interest and most gynaecologists are therefore not familiar with them. We review the currently available instrumentation used during operations for complicated monochorionic multiple pregnancies, congenital diaphragmatic hernia, amniotic band syndrome, urinary tract obstruction and hydrothorax.

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Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions

Cited by 30 publications

References 20 publications

The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

Advances in fetal surgery

Instrumental requirements for minimal invasive fetal surgery

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