Instrumental requirements for minimal invasive fetal surgery

Abstract

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.

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

“…Since the first report [6] of fetoscopic laser surgery in 1990, many different entry techniques, instruments and access diameters have been described for this procedure [7]. Any refinements in instrumentation and technique have been made to improve efficacy and reduce complications [8].…”

“…Alternatively, the cannula is inserted directly with a trocar, similar to laparoscopic entry (cannula + trocar) [12]. Access outer diameters for fetoscopic surgery reportedly range from 2.3 mm (7 French) to 4.0 mm (12 French) [7]. …”

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

“…In such settings, the learning curve, as well as low caseload, might affect efficacy and outcomes (Klaritsch et al, 2009). Yet these challenges are not unique to FLP: they are common to many fetal interventions, and have fueled robust debate.…”

Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models

“…With these fetoscopic techniques, although reporting has been incomplete, there appears to be a higher rate of fetal loss, hemorrhagic complications, premature delivery, and technical failure to achieve closure [17,18,19]. To improve upon the results of open fetal surgery, truly minimally invasive techniques that could be performed rapidly through a single trocar or at most 2 small (≤2 mm) trocars will probably be needed [20]. These requirements are prohibitive for standard surgical techniques of tissue dissection and suturing and will require a simplified method to achieve tissue coverage.…”