Gasless Fetoscopy: A New Approach to Endoscopic Closure of a Lumbar Skin Defect in Fetal Sheep

• Published in: Fetal diagnosis and therapy Vol. 23; no. 4; pp. 293 - 298
• Main Authors: Pedreira, D.A.L., Oliveira, R.C.S., Valente, P.R., Abou-Jamra, R.C., Araújo, A., Saldiva, P.H.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2008; S. Karger AG
• Subjects: Animals; Biological and medical sciences; Delivery. Postpartum. Lactation; Disease Models, Animal; Diseases of the osteoarticular system; Female; Fetoscopy - methods; General aspects; Gynecology. Andrology. Obstetrics; Humans; Lumbosacral Region; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Meningomyelocele - surgery; Pilot Projects; Pregnancy; Sheep; Skin Abnormalities - surgery; Spinal Dysraphism - surgery; Animal models; Fetoscopy; Endoscopy; Meningomyelocele; Sheep, spina bifida, open; Animal model; Skin disease; Skin defect; Closure; Lumbar spine; Diseases of the osteoarticular system; Neonatology; Amniofetoscopy; Spine disease; Fetus; Myelomeningocele; Ungulata; Nervous system diseases; Congenital disease; Pregnancy; Medicine; Spina bifida; Vertebrata; Mammalia; Malformation; Animal; Central nervous system disease; Sheep; Artiodactyla; Lumbar; Spinal cord disease
• ISSN: 1015-3837; 1421-9964
• DOI: 10.1159/000123616

Objective: To develop a new endoscopic approach to the correction of a myelomeningocele-like defect in fetal sheep. Methods: The fetuses of 9 pregnant ewes, with an average gestational age of 115 days, were subjected to a 3.0 × 2.0 cm removal of the skin over the lumbar spine, performed through hysterotomy. The uterus was closed, and three 5-mm endoscopic cannulas, without valve mechanisms, were inserted. In the pilot phase (2 animals), we initially worked exclusively in the amniotic fluid space. In the study phase, we partially withdrew the fetus from the amniotic fluid to completely expose its back. By simply allowing air to enter the amniotic cavity (without gas injection), a working space was created using a uterine lift device. The skin around the defect was dissected, and a biosynthetic cellulose material was applied to cover the area. A continuous suture of the skin was performed to completely hide the material. Results: The combined air/fluid space allowed the skin to be successfully closed in 6 out of 7 cases in the study phase. All fetuses were alive at the end of the procedures. Time to complete the endoscopic part of the procedure fell from 3 to 1 h by the end of this series. Premature birth occurred in 2 of the 4 cases allowed to continue with the pregnancy. Conclusion: A new gasless fetoscopic surgery technique was developed as an alternative to current techniques used for fetal endoscopic surgery.