Fetal surgery

Fetal surgery or, less commonly, fetal surgery denotes the option of prenatal surgery as part of in utero therapy for particularly severe or life-threatening malformations or diseases of the growing fetus .

description

A fetus can be operated both openly (the uterus and the amniotic sac are opened, the fetus rotated accordingly and then operated on) as well as minimally invasive (using instruments inserted into the amniotic sac through trocars ). The operations require a well-rehearsed team that includes gynecologists, anesthetists and surgeons on the medical side, the latter from various specialist disciplines, e.g. B. Pediatric surgery, neurosurgery, pediatrics can come. A major problem lies in stabilizing the pregnancy after the operation is finished. If the pregnancy cannot be stabilized, premature birth occurs .

history

Michael Harrison attempted the first open operation on a fetus in 1981. Open surgery means that during these first and many subsequent interventions, the pregnant woman's abdomen was opened and the fetus was partially or completely removed in order to prenatally close a spina bifida aperta , for example . This led to discussions and considerations about risks and benefits, as the premature birth rate in particular was very high.

Researchers and employees from the University of Münster and the University of Bonn have developed a procedure that allows access to the child and thus the possibility of operating through three small, approximately 5 × 2 mm tubes (fetoscope or trocars). This method has led to the fact that the pregnancy can be maintained up to the 30th week of pregnancy after an operation .

Since interventions (diagnosis or surgery) on embryos or fetuses are rarely practiced at the moment, there are correspondingly few or no sources for fetal surgery. On this occasion, the European Commission (Biomed II) launched the “Eurofoetus” initiative in order to work with science and industry to come up with meaningful studies and standardized surgical procedures.

Examinations, indications and operable malformations

• Forms of the Spina bifida aperta
• Congenital diaphragmatic hernia
• Coccyx teratomas with heart failure
• Discordant twin pregnancies
• Acranius acardius
• Twin transfusion syndrome / fetofetal transfusion syndrome
• Congenital complete heart block , atrioventricular block (AV block) with heart failure
• Severe narrowing of the fetal aortic and pulmonary valves
• Supraventricular tachycardia = racing heart with heart failure
• Larynx and trachea closures ( fetal CHAOS e.g. in laryngeal atresia )
• Fetal biopsies and diagnostic fetoscopies
• Gastroschisis
• Severe narrowing of the foramen ovale (foramen ovale restriction)
• Hydrothorax
• Posterior urethral valves (urinary flow disorders)
• Coarctation of the aorta (or interrupted aortic arch , underdevelopment of the left heart, left heart hypoplasia, coarctation)
• premature rupture of the bladder (therapy to improve lung development)

Executing and participating clinics and institutions

• German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT, University Hospital Mannheim )
• University of Münster , neurosurgery and children's clinic
• University Medical Center Hamburg-Eppendorf
• Children's Center University Hospital Mannheim ( ECMO )
• Women's clinic and polyclinic of the Klinikum rechts der Isar (Technical University of Munich)
• Monroe Carell Jr. Children's Hospital at Vanderbilt
• The Children's Hospital of Philadelphia

Web links

• Fetal surgery - operation in the womb Ramonafp, April 16, 2016 on fruehchen-portal.de

Individual evidence

1. ↑ German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT) ( Memento of the original from March 10, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
2. ↑ Endoscopic access to the fetoplacental unit: from experimental to clinical applications
3. ↑ UMM: Fetal Therapy: Mannheim University Hospital. Retrieved July 25, 2018 . 
4. ↑ UMM: ECMO lung replacement therapy: University Hospital Mannheim. Retrieved July 25, 2018 . 
5. ↑ Help before the birth - minimally invasive fetal surgery can save babies with dangerous malformations ( Memento of the original from December 1, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
6. ↑ Childrens Hospital at Vanderbilt. Retrieved July 25, 2018 . 
7. ^ The Children's Hospital of Philadelphia: Division of Pediatric General, Thoracic and Fetal Surgery. May 5, 2014, accessed July 25, 2018 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !