In utero surgery – current state of the art – part II

Abstract

SummaryBackgroundFetal surgery, also referred to as in utero, prenatal or intrauterine surgery, consists of treatment of congenital malformations during the fetal period. The idea of treating malformations diagnosed in the course of intrauterine life dates back to 1963, when Lilly performed the first blood transfusion in a fetus. Since then it has been introduced as a treatment option in a series of lethal malformations. Efforts are being made to treat nonlethal malformations by means of fetal surgery.Material/MethodsA comprehensive search of the literature using MEDLINE and PubMed between 1925 and February 2009 was performed. Search terms for MEDLINE and PubMed were: fetal surgery, foetal surgery, in utero surgery, prenatal surgery, and in utero treatment. In addition, information was obtained at Web sites of the International Medicine and Surgery Society and the University of California Fetal Treatment Centre.ResultsAuthors’ attention focused on the survey of indications to intrauterine operations. We outline potential directions of its development, quoting the groundwork of the most experienced researchers and clinicians. Moreover, owing to the authors’ interest in plastic surgery, some remarks on the role of intrauterine medicine and surgery in this branch of medicine are made.ConclusionsIn utero surgery may be regarded as an efficient tool of preventive medicine. It offers some advantages that no other branch of medicine may offer. However, its implementation is more troublesome than in the past, therefore only selected cases may benefit from its advantages. Nevertheless, current tendencies are to include, after thorough evaluation of benefit-risk ratio, some new indications for fetal surgery.

Tracheo-bronchial angles in the human fetus – an anatomical, digital, and statistical study

“…The advancement of visual techniques implemented in perinatal medical care enables surgeons and anesthesiologists to perform airway management and to detect, monitor, and surgically treat life-threatening anomalies of the fetal tracheo-bronchial tree [1–11]. Thus, the tracheo-bronchial angles in the human fetus are of increasing relevance in perinatal medicine to determine both normal and pathological criteria adapted to anatomical particularities of the fetal tracheo-bronchial tree [11–13].…”

New quantitative patterns of the growing trachea in human fetuses

“…Although in-utero surgery, being still experimental in most centers, is performed from 18 weeks, the placenta acts as the fetus’ cardiopulmonary by-pass machine, thereby negating a need for manipulation or cannulation of the airways. However, numerical data on fetal tracheas are relevant in prenatal surgery involving the tracheo-bronchial tree [1,2]. Studies on tracheal obstruction in the treatment of congenital diaphragmatic hernias [3,4] included fetuses at the age of 20 weeks and older.…”

Quantitative anatomy of the growing abdominal aorta in human fetuses: An anatomical, digital and statistical study

“…Nowadays, the advancing resolution capabilities of ultrasound devices lead to an increase in in utero diagnostic examinations [5,6,9]. Thus, in fetuses, neonates and infants, the following arterial malformations can be expected at the level of the abdominal aorta: abdominal aortic aneurysms, abdominal aortic hypoplasia, abdominal aortic atresia, infrarenal abdominal aortic agenesis, and idiopathic infantile calcification.…”

“…Advances in perinatal medicine require an extensive knowledge of fetal aorto-iliac morphological data [5,10]. The normative morphometric data of the abdominal aorta in human fetuses may be helpful as a reference for future Doppler studies in the prenatal diagnosis and monitoring of congenital aortic abnormalities (eg, aneurysms, hypoplasia, atresia, agenesis, and idiopathic infantile arterial calcification) that include discordant diameters of the aorta and its great branches [11–17].…”