Fetoscopic management of gastroschisis in a lamb model

Krebs, Thomas; Wenke, Katharina; Andreas, Thomas; Tiemann, Bastian; Paetzel, Julia; Jacobsen, Birte; Fahje, Rebecca; Schmitz, Carlos André Aita; Mann, Oliver; Roth, Beate; Appl, Birgit; Hecher, Kurt

doi:10.1007/s00464-011-2048-8

Cited by 16 publications

(19 citation statements)

References 13 publications

(16 reference statements)

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“…By reviewing the operative video, we found that during the creation of the gastroschisis the procedure was aborted without complete incision of the rectus abdominis muscle due to bleeding. Bleeding was commonly seen during the process of gastroschisis creation; however, it did not lead to fetal demise except in one fetus, which was reported in our earlier series [8]. …”

Section: Discussionmentioning

confidence: 48%

“…Nineteen time-dated singleton pregnant German blackhead ewes (Ovis aries orientalis) were used. Of these, 7 animals from our previous publication were included with new data [8]. The access into the uterine cavity was made by sonographically guided percutaneous needle puncture.…”

Section: Methodsmentioning

confidence: 99%

“…When we performed our first series of the fetoscopic creation of gastroschisis in sheep, the aim was to extract a loop of bowel through the abdominal incision [8]. As this procedure had to be abandoned in one case due to bleeding, only omentum was left outside of the fetus.…”

Section: Introductionmentioning

confidence: 99%

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Abdominal Wall Incision with or without Exteriorization of Bowel: Results from a Fetal Lamb Model for the Embryogenesis of Gastroschisis

Krebs¹,

Wenke²,

Boettcher³

et al. 2012

Fetal Diagn Ther

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Introduction: The embryogenesis of gastroschisis is not completely understood. The aim of our study was to evaluate the impact of a simple abdominal wall defect versus a defect including eviscerated intestine or omentum for the development of gastroschisis in a fetal lamb model. Material and Methods: At mid-gestation (day 77) an abdominal wall defect was fetoscopically created with three different approaches in 19 German blackhead sheep. The intestine was eviscerated in 7 fetuses (group 1). The peritoneum was incised and a patch of the omentum pulled through the incision in 5 fetuses (group 2). In 7 fetuses (group 3) the skin and rectus muscle were incised until the peritoneum was visible. In this group, no abdominal contents were exteriorized and the peritoneum was left intact. A second fetoscopic procedure was performed 21 days later, assessing the condition and extension of eviscerated bowel. The fetus was retrieved by Cesarean section on day 132 and evaluated. Results: The second fetoscopy acting as a control for the creation of gastroschisis demonstrated eviscerated and inflamed intestine in all 3 groups. The amount of eviscerated intestine did not appear to depend on the size of the defect nor on its duration. Discussion: It appears that a simple incision of the abdominal wall with intact peritoneum is sufficient for the development of gastroschisis in a fetal sheep model. This finding may improve the understanding of the etiology of gastroschisis.

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Section: Discussionmentioning

confidence: 48%

Section: Methodsmentioning

confidence: 99%

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Abdominal Wall Incision with or without Exteriorization of Bowel: Results from a Fetal Lamb Model for the Embryogenesis of Gastroschisis

Krebs¹,

Wenke²,

Boettcher³

et al. 2012

Fetal Diagn Ther

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“…Even though great hopes for reduction of morbidity and mortality are based on fetoscopic repairs, its implementation has been limited due to technical difficulties resulting in premature labor or fetal demise. [1][2][3][4] Consequently, current fetoscopic treatment options are restricted to a well-formulated setting, such as the introduction of a tracheal plug in congenital diaphragmatic hernia, drainage for lower urinary tract obstruction, and coagulation of placental vessels for twin-totwin transfusion syndrome. 5,6 The implementation of more complex fetoscopic procedures has been limited due to technical difficulties that are partly attributed to the different visualization under water.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 The implementation of more complex fetoscopic procedures has been limited due to technical difficulties that are partly attributed to the different visualization under water. 1,2 Some authors propose to insufflate carbon dioxide into the uterus to overcome these obstacles. 7 However, the risks for preterm labor due to fetal stress after intrauterine carbon dioxide insufflation are high and the transfer of this technique to humans seems unadvisable.…”

Section: Introductionmentioning

confidence: 99%

Training Significantly Improves Fetoscopy Performance: A Pilot Randomized Controlled Trial

et al. 2015

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Implementation of complex fetoscopic procedures that included intracorporeal suturing has been limited due to technical difficulties that might be surmounted with adequate training. Evaluating the impact of laparoscopic or fetoscopic training on fetoscopic performance was the aim of this study. To evaluate fetoscopic performance after either laparoscopic or fetoscopic training, subjects were asked to perform four surgeon's square knots fetoscopically prior and post 2 hours of hands-on training. All subjects were medical students and novice in laparoscopic and fetoscopic interventions. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality, and fetoscopic performance were assessed. Forty-six subjects were included in the study; after simple randomization, 24 were trained fetoscopically and 22 laparoscopically. Both groups had comparable baseline characteristics and improved after training significantly regarding all aspects assessed in this study. Subjects who trained fetoscopically were superior in terms of suturing and knot-tying performance. Training significantly improves fetoscopic performance and may indeed be the keystone for future complex fetoscopic interventions. It seems advisable to train rather fetoscopically than laparoscopically resulting in higher suture and knot-tying quality.

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Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

et al. 2020

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We conducted a comprehensive evidence‐based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second‐trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long‐ and short‐term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.

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Fetoscopic management of gastroschisis in a lamb model

Abstract: Although technically demanding, we were able to produce and reassess six cases of gastroschisis by fetoscopy. As primary repositioning appears unfavorable, fetoscopic prosthetic bag placement may become an alternative.

Cited by 16 publications

References 13 publications

Abdominal Wall Incision with or without Exteriorization of Bowel: Results from a Fetal Lamb Model for the Embryogenesis of Gastroschisis

Abdominal Wall Incision with or without Exteriorization of Bowel: Results from a Fetal Lamb Model for the Embryogenesis of Gastroschisis

Training Significantly Improves Fetoscopy Performance: A Pilot Randomized Controlled Trial

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

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