Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans

Kohl, Thomas; Tchatcheva, K.; Weinbach, Julia; Hering, R.; Kozlowski, P.; Stressig, R; Gembruch, Ulrich

doi:10.1007/s00464-009-0579-z

Cited by 45 publications

(58 citation statements)

References 9 publications

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“…These groups later abandoned their FSBAR program and transitioned to OSBAR because of a combination of technical failures, complications and fetal death. Two case reports and 1 case series (n = 2, 3 and 16, respectively) from Kohl et al [19,20,21] were excluded because the data were incomplete and reported in a later article (n = 19) [22]. One case report from Pedreira et al [36] was also excluded since all cases have been included in a later more complete study.…”

Section: Resultsmentioning

confidence: 99%

“…The closure technique in the hands of Kohl's group evolved over time. In the early experience (≤30 cases), closure consisted of a double layer of patches (Durasis® fascia patch covered by a Gore® Preclude® Pericardial Membrane skin patch) or a single layer of Gore® Preclude® skin patch [20,21,22]. In the later experience on 51 FSBAR procedures, except for one incomplete closure, repair consisted of either a single layer of Surgisis® skin patch (n = 30/50, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…In Europe, the technique was pioneered by Kohl et al [19], initially in Bonn (Germany). Over the years, these surgeons accumulated a large surgical experience, which they published in different reports [20,21]. Neonatal outcomes, as independently assessed by a Dutch team [22], are available for a limited number of their patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

164

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Objective: To compare outcomes of fetoscopic spina bifida aperta repair (FSBAR) with the results of the open approach (OSBAR) as in the Management Of Myelomeningocele Study (MOMS). Methods: This was a systematic comparison of reports on FSBAR with data from the MOMS (n = 78). Inclusion criteria were studies of spina bifida aperta patients who underwent FSBAR and were followed for ≥12 months. Primary outcome was perinatal mortality. Secondary outcomes included operative, maternal, fetal, neonatal and infant outcomes. Results: Out of 16 reports, we included 5 from 2 centers. Due to bias and heterogeneity, analysis was restricted to two overlapping case series (n = 51 and 71). In those, FSBAR was technically different from OSBAR, had comparable perinatal mortality (7.8 vs. 2.6%, p = 0.212) and shunt rate at 12 months (45 vs. 40%, p = 0.619), longer operation time (223 vs. 105 min, p < 0.001), higher preterm prelabor membrane rupture rate (84 vs. 46%, p < 0.001), earlier gestational age at birth (32.9 vs. 34.1 weeks, p = 0.03), higher postnatal reoperation rate (28 vs. 2.56%, p < 0.001) and absence of uterine thinning or dehiscence (0 vs. 36%, p < 0.001). Functional outcomes were not available. Conclusion: FSBAR utilizes a different neurosurgical technique, takes longer to complete, induces more prematurity, requires additional postnatal procedures, yet has a comparable shunt rate and is not associated with uterine thinning or dehiscence. Long-term functional data are awaited.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

164

View full text Add to dashboard Cite

show abstract

“…The patients reported on by Danzer et al [30], Friszer et al [31], Moldenhauer et al [32], Zamłyński et al [33], Bennett et al [34], and Hisaba et al [35] underwent open fetal repair of MMC. For each of the 11 studies, the data The patients reported on by Degenhart et al [28] overlap with those reported on by Kohl [12] in 2014, and the patients reported on by Verbeek et al [29] overlap with those reported on by Kohl et al [11] in 2010. The preliminary findings reported by Pedreira et al [13] in 2014 are also reported in 2016 [27], after completion of the study.…”

Section: Study Characteristicsmentioning

confidence: 44%

“…Proponents of fetoscopic MMC repair argue that this minimally invasive approach reduces the rate of obstetrical complications associated with open fetal MMC repair [10][11][12][13]. However, critics have argued that the high rates of membrane rupture and premature birth -combined with the inability to reliably perform a watertight closure of the MMC defect, thus necessitating postnatal revision of the repair -challenge the notion that fetoscopic MMC repair is associated with less morbidity than open fetal repair [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Fetal Surgery for Myelomeningocele: A Systematic Review and Meta-Analysis of Outcomes in Fetoscopic versus Open Repair

et al. 2017

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Background/Objectives: The Management of Myelomeningocele (MMC) Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes but was associated with high rates of obstetrical complications. This study compares outcomes of open and fetoscopic MMC repair. Data Sources: PubMed and Embase studies reporting outcomes of fetal MMC repair published since the completion of the MOMS. Results: We analyzed 11 studies and found no difference in mortality or the rate of shunt placement for hydrocephalus. Percutaneous fetoscopic repair was associated with higher rates of premature rupture of membranes (91 vs. 36%, p < 0.01) and preterm birth (96 vs. 81%, p = 0.04) compared to open repair, whereas fetoscopic repair via maternal laparotomy reduced preterm birth. The rate of dehiscence and leakage from the MMC repair site was higher after both types of fetoscopic surgery (30 vs. 7%, p < 0.01), while the rate of uterine dehiscence was higher after open repair (11 vs. 0%, p < 0.01). Discussion: Fetoscopic repair is a promising alternative to open fetal MMC repair with a lower risk of uterine dehiscence; however, fetoscopic techniques should be optimized to overcome the high rate of dehiscence and leakage at the MMC repair site. A fetoscopic approach via maternal laparotomy reduces the risk of preterm birth.

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Partial amniotic carbon dioxide insufflation for fetal surgery

et al. 2018

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Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra‐amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well‐being.

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Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans

Abstract: PACI greatly improves fetal visualization during fetoscopic interventions when fetoscopy within fluid meets with difficulties. Continued assessment of its benefits, risks, and safety margins at specialist centers is required.

Cited by 45 publications

References 9 publications

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Fetal Surgery for Myelomeningocele: A Systematic Review and Meta-Analysis of Outcomes in Fetoscopic versus Open Repair

Partial amniotic carbon dioxide insufflation for fetal surgery

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