Bilan de cinq années de chirurgie expérimentale in utero pour la réparation des hernies diaphragmatiques

Esteve, Cristina; Toubas, F; Gaudiche, O; Lévêque, C.; Bargy, F.; Rouquet, Yves; Sapin, Emmanuel; Murat, I.; Saint-Maurice, C

doi:10.1016/s0750-7658(05)80012-7

Cited by 18 publications

(1 citation statement)

References 25 publications

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“…However, the formid able insult to mother and fetus has hampered expansion of this approach to more than a few selected indications [1] -and a few special ized centers world-wide [2,3]. The recent developments in video-endoscopic tech niques have offered new hope for the future of in utero surgery.…”

Section: Introductionmentioning

confidence: 99%

Carbon Dioxide Pneumoamnios Causes Acidosis in Fetal Lamb

Luks

Deprest

Marcus³

et al. 1994

Fetal Diagn Ther

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Recently developed techniques of video-endoscopic surgery may offer new hope for the future of fetal surgery. To allow this approach, the amniotic cavity has to be temporarily enlarged, either by carbon dioxide (CO₂) insufflation or by amnioinfusion. In 6 anesthetized ewes, CO₂ insufflation of the amniotic cavity produced severe fetal hypercapnia (from 57.6 ± 1.6 to 87.0 ± 7.0 torr) and acidosis (from 7.22 ± 0.03 to 7.11 ± 0.08) despite normal maternal CO₂ pressure and pH. CO₂ pneumoamnios does not therefore appear to be an ideal working medium. Fetal endoscopic surgery through amnioinfusion of physiologic fluid may be a safer alternative.

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Section: Introductionmentioning

confidence: 99%

Carbon Dioxide Pneumoamnios Causes Acidosis in Fetal Lamb

Luks

Deprest

Marcus³

et al. 1994

Fetal Diagn Ther

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The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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