Fetal surgery

Fötalchirurgie or fetal surgery also refers to the possibility of prenatal surgery as part of a therapy in utero to especially severe or life-threatening malformations or diseases of the growing fetus.

Description

A fetus can both open ( the uterus and amniotic sac are opened, the fetus rotated accordingly and then surgery ) as well as minimally invasive surgery ( means into the amniotic sac of introduced through trocars instruments). The operations need a team that medically includes gynecologists, anesthetists and surgeons, for example, the latter being from different disciplines can pediatric surgery, neurosurgery, pediatrics come. A major problem is the stabilization of the operation after the end of pregnancy. If the pregnancy does not stabilize, it comes to premature birth.

History

Michael Harrison ventured in 1981, the first open operation on a fetus. Open surgery here means that these first and many subsequent engagements of the belly of the pregnant woman and the fetus was opened partly or completely removed by an example, present spina bifida to close before birth. This led to discussions and considerations about risks and benefits, as especially the premature birth rate was very high.

Researchers and staff of the University of Münster and the University of Bonn have developed a method in which the access to the child and thus the possibility to operate on three small, approximately 5 × 2 mm tube ( fetoscope or trocars ) is possible. This method has led to the pregnancy after an intervention to the 30th week of pregnancy can hold.

Since current procedures ( diagnostic or surgery ) in embryos or fetuses are rarely practiced, are accordingly little to no sources for Fötalchirurgie available. For this occasion, the European Commission ( Biomed II) has the " Eurofoetus " initiative launched to get together with academia and industry to meaningful studies and standardized surgical procedures.

Studies, indications and interoperable malformations

  • Forms of spina bifida aperta
  • Congenital diaphragmatic hernia
  • Steißbeinteratome with heart failure
  • Discordant twin pregnancies
  • Acranius acardius
  • Twin transfusion syndrome / Fetofetales Transfusionssyndrom
  • Congenital complete heart block, atrioventricular block (AV block) with heart failure
  • Severe narrowing of the fetal aortic and pulmonary valves
  • Supraventricular tachycardia = rapid heartbeat with heart failure
  • Larynx and trachea closures ( fetal CHAOS eg Larynxatresie )
  • Fetal Diagnostic biopsies and Fetoskopien
  • Gastroschisis
  • High-grade stenosis of the foramen ovale ( patent foramen ovale restriction )
  • Hydrothorax
  • Posterior urethral valves ( urinary obstruction )
  • Coarctation of the aorta (or interrupted aortic arch, underdevelopment of the left heart, Linksherzhypoplasie, Coarctation )
  • With premature rupture of membranes (therapy to improve lung development )

Performers and participated clinics and institutions

  • German Center for Fetal Surgery & Minimally Invasive Therapy ( DZFT, University Hospital Giessen)
  • University of Münster, Neurosurgery and Children's Hospital
  • University Medical Center Hamburg -Eppendorf
  • Children's Center Mannheim ( ECMO)
  • Women's Hospital and Polyclinic Hospital rechts der Isar (Technical University of Munich)
  • The Children 's Hospital of Philadelphia
Congenital disorder Fetoscopy Extracorporeal membrane oxygenation
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