Fetoscopic single-layer repair of open spina bifida using a cellulose patch: preliminary clinical experience

Abstract

Objective: To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique.

Methods: Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch.

Results: Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases.

Conclusions: Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.

• Cellulose
• fetal therapy
• fetoscopy
• meningomyelocele
• myelomeningocele
• spina bifida

Acknowledgements

We wish to acknowledge Dr. Paulo H. Saldiva, Dr. Silvia Herrera, Dr. Marcus Vinícius Bittencourt, Dr. Vania Zito and Dr. Patrícia Soares de Oliveira for their significant contribution to the experimental research, clinical application, anaestethic development and imaging analyses, respectively. We also would like to thank Dr. Thomas Kohl for his incentive and support during our initial clinical experience.