Endoscopic Release of Limb Constriction Rings in utero

Abstract

Amniotic band syndrome is a sporadic condition that may result in constriction bands, amputation and multiple craniofacial, visceral and body wall defects. It occurs in 1/1,200 to 1/15,000 live births. Most cases present with multiple congenital anomalies that are incompatible with life. A small group of fetuses shows isolated limb constrictions that may cause severe limb dysfunction or limb amputation if left untreated. Successful in utero surgical lyses of constriction rings have been reported. We report a case of constriction amniotic bands involving both legs and compromising blood flow to the distal extremity. The constriction ring was successfully released by a minimally invasive endoscopic surgical technique avoiding severe limb dysfunction or foot amputation.

Perinatal outcome after fetoscopic release of amniotic bands: a single‐center experience and review of the literature

“…Advancements in fetal endoscopic technology, coupled with increasing experience and lower fetal-maternal risk, have led to an increased acceptance of minimally invasive fetal surgery as a treatment option for ABS 17 . Although there were two unsuccessful interventions in this collective and selected series of cases, it is believed that limb function was saved by intervention in the remaining cases.…”

Amniotic Constriction Band: A Multidisciplinary Assessment of Etiology and Clinical Presentation

“…Much milder findings with a near normal limb appearance were noted when the band was released fetoscopically twenty-five days later. Others [47][48][49] reported fetoscopic release at approximately twenty weeks gestation in humans, with improvement in the appearance of the extremities. These reports do not advocate isolated fetoscopic release, as the risks of such intervention are high.…”

Instrumental requirements for minimal invasive fetal surgery

“…52 The first clinical attempts for in utero release of amniotic bands were described by Quintero et al, 53 and since then several reports have been published. 54,55 It may be quite difficult to identify and release the membrane constriction deep within edematic tissue. The instruments required are, next to a fetoscope, adapted sheaths and laser energy, but that may cause collateral damage.…”