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Percutaneous/mini-laparotomy fetoscopic repair of open spina bifida: a novel surgical technique

  • Ramen H. CHMAIT
    Correspondence
    Corresponding Author: Ramen H. Chmait, MD, Director, Los Angeles Fetal Surgery, Professor of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 39 Congress St. Suite 302, Pasadena, California 91105, USA Tel: (626) 356-3360 [email protected]
    Affiliations
    Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA

    The USFetus Research Consortium, Miami, FL-Los Angeles, CA
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  • Martha A. MONSON
    Affiliations
    Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
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  • Huyen Q. PHAM
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Jason K. CHU
    Affiliations
    Department of Neurosurgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Alexander VAN. SPEYBROECK
    Affiliations
    Department of General Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Andrew H. CHON
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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  • Eftichia V. KONTOPOULOS
    Affiliations
    The Fetal Institute, Miami, FL

    The USFetus Research Consortium, Miami, FL-Los Angeles, CA

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wertheim School of Medicine, Florida International University, Miami, FL
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  • Ruben A. QUINTERO
    Affiliations
    The Fetal Institute, Miami, FL

    The USFetus Research Consortium, Miami, FL-Los Angeles, CA

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wertheim School of Medicine, Florida International University, Miami, FL
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      Abstract

      Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system compatible with life. Prenatal repair of open spina bifida via open maternal-fetal surgery has been shown to improve postnatal neurological outcomes, including reducing the need for ventriculoperitoneal shunting and improving lower neuromotor function. Fetoscopic repair of OSB minimizes the maternal risks while providing similar neurosurgical outcomes to the fetus. Two fetoscopic techniques are currently in use: (1) the laparotomy-assisted approach, and (2) the percutaneous approach. The laparotomy-assisted fetoscopic technique appears to be associated with less risk of preterm birth compared to the percutaneous approach. However, the percutaneous approach avoids laparotomy and uterine exteriorization, and is associated with less anesthesia risk and improved maternal post-surgical recovery. The purpose of this paper is to describe our experience with a novel surgical approach, which we call percutaneous/mini-laparotomy fetoscopy (PML), in which access to the uterus for one of the ports is done via a mini-laparotomy, while the other ports are inserted percutaneously. This technique draws on the benefits of both the laparotomy-assisted and the percutaneous techniques, while minimizing their drawbacks. This surgical approach may prove invaluable in the prenatal repair of open spina bifida as well as other complex fetal surgical procedures.

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