The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

Deka, Dipika; Dadhwal, Vatsla; Gajatheepan, S. B.; Singh, Aprajita; Sharma, K Aparna; Malhotra, Neena

doi:10.1007/s13224-012-0232-y

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…As technology has advanced, such invasive intrauterine procedures have ceased to be the norm. Fetal endoscopic surgical techniques, or 'Fetendo', are performed under US guidance, with fetal structures viewed on a monitor 5,6 . With minimal invasion, complication rates have reduced considerably: Sacco et al 7 in their literature review reported that of fetoscopic surgery to be 6%, compared with 21% for open surgery.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional real and virtual models in fetal surgery: a real vision

Okpaise

Tonni

Werner

et al. 2024

Ultrasound in Obstet & Gyne

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While relatively new, fetal surgery has become an indispensable part of the field of Obstetrics as it allows potentially life‐threatening conditions to be corrected in utero. Imaging modalities such as ultrasound, magnetic resonance imaging, and computer tomography have become staples in fetal imaging, as they allow for comprehensive analysis of the fetal anatomy. Uses of these modalities can range from chromosomal diagnosis to surgical planning. Scientific development has not only allowed for visualization in the three‐dimensional plane, but the implementation of virtual reality technology is also now a possibility. It is our belief that integrating virtual reality technology will help overcome hurdles currently faced by fetal surgeons including candidate selection and clearly observing fetal anatomy. Training opportunities are also probably, as surgeons and residents can use models created during these virtual reality experiences to study and prepare for complications that may arise during surgical intervention.This article is protected by copyright. All rights reserved.

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Section: Introductionmentioning

confidence: 99%

Three‐dimensional real and virtual models in fetal surgery: a real vision

Okpaise

Tonni

Werner

et al. 2024

Ultrasound in Obstet & Gyne

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“…These procedures had been mostly done using open surgical methods, which, with the progression in technology, have been transformed into minimal invasive surgeries. 1 Minimal access fetal surgery is a form of minimally invasive surgery (MIS), where, unlike most other MIS, the procedure is highly restricted in terms of field of view, dexterity, force perception, and orientation, leading to limitations in the number and type of procedure done. Many congenital conditions such as congenital diaphragmatic hernia (CDH), twin to twin transfusion syndrome, spina bifida, and so on, can be treated using minimal access procedures.…”

Section: Introductionmentioning

confidence: 99%

“…For example, less invasive fetal procedures such as minimally invasive tracheal balloon occlusion are being developed as effective alternatives to open surgeries. Randomized controlled trials were conducted 1-5 to determine whether fetal endoscopic tracheal occlusion improved survival in cases of CDH.…”

Section: Introductionmentioning

confidence: 99%

A Multimodality Navigation System for Endoscopic Fetal Surgery: A Phantom Case Study for Congenital Diaphragmatic Hernia

2018

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This paper aims to present and evaluate a robotic-assisted Multimodality Navigation system for use in Endoscopic Fetal Surgery. Fetal surgery is an emerging field of minimally invasive surgery, which uses ultrasound guidance, where the entire procedure is done within a constrained anatomical volume and suffers from the difficulties of limited working space. Fetal surgeries require extensive experience in coordination of hand-eye-ultrasound-surgical equipment, knowledge and precise assessment of relative anatomy. As a result, such surgeries require skills that can only be acquired over long periods of training. While there are navigation systems available for similar constrained working spaces in arthroscopic and cardiovascular procedures, fetal minimally invasive surgery does not yet have a dedicated navigation platform capable of supporting robotic instruments which can be adapted to the set of unique procedures. This paper discusses the testing of the said novel multimodality navigation system in a phantom environment developed for this purpose. The outcomes suggest that the subjects demonstrated an increase in average reaching accuracy by about 60% and an overall reduction in time taken by 33.6%. They also, showed higher levels of confidence in reaching the targets, which was visualized from the pattern of trajectory of movements during the procedure. Background Methods This paper presents a Multi-modality tracking and navigation system achieved by merging optical tracking and ultrasound imaging into a novel navigation software to help the surgical pre-planning and real-time target setting and guidance. To evaluate the navigation system, a phantom surgical environment was found necessary.

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Fetoscopic versus Ultrasound-Guided Intravascular Delivery of Maternal Bone Marrow Cells in Fetal Macaques: A Technical Model for Intrauterine Haemopoietic Cell Transplantation

et al. 2019

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Introduction: Significant limitations with existing treatments for major haemoglobinopathies motivate the development of effective intrauterine therapy. We assessed the feasibility of fetoscopic and ultrasound-guided intrauterine haemopoietic cell transplantation (IUHCT) in macaque fetuses in early gestation when haemopoietic and immunological ontogeny is anticipated to enable long-term donor cell engraftment. Material and Methods: Fluorescent-labelled bone marrow-derived mononuclear cells from 10 pregnant Macaca fascicularis were injected into their fetuses at E71–114 (18.9–170.0E+6 cells/fetus) by fetoscopic intravenous (n = 7) or ultrasound (US)-guided intracardiac injections, with sacrifice at 24 h to examine donor-cell distribution. Results: Operating times ranged from 35 to 118 min. Chorionic membrane tenting and intrachorionic haemorrhage were observed only with fetoscopy (n = 2). Labelled cells were stereoscopically visualised in lung, spleen, liver, and placenta. Donor-cell chimerism was highest in liver, spleen, and heart by flow cytometry, placenta by unique polymorphism qPCR, and was undetected in blood. Chimerism was 2–3 log-fold lower in individual organs by qPCR than by flow cytometry. Discussion: Both fetoscopic and US-guided IUHCT were technically feasible, but fetoscopy caused more intraoperative complications in our pilot series. The discrepancy in chimerism detection predicts the challenges in long-term surveillance of donor-cell chimerism. Further studies of long-term outcomes in the non-human primate are valuable for the development of clinical protocols for IUHCT.

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The Art of Fetoscopy: A Step Toward Minimally Invasive Fetal Therapy

Cited by 6 publications

References 17 publications

Three‐dimensional real and virtual models in fetal surgery: a real vision

Three‐dimensional real and virtual models in fetal surgery: a real vision

A Multimodality Navigation System for Endoscopic Fetal Surgery: A Phantom Case Study for Congenital Diaphragmatic Hernia

Fetoscopic versus Ultrasound-Guided Intravascular Delivery of Maternal Bone Marrow Cells in Fetal Macaques: A Technical Model for Intrauterine Haemopoietic Cell Transplantation

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