FROM THE 16TH SLS ANNUAL MEETING AND ENDO EXPO 2007, SAN FRANCISCO, CALIFORNIA, SEPTEMBER 5–8, 2007
PRESENTED BY JOSEPH BRUNER, MD
The types of fetal surgeries being performed are growing. The first in utero surgery was bladder open fetal surgery for lower urinary tract obstruction (LUTO). Liver surgery has been performed, as has congenital high airway obstruction (CHAOS) surgery. PLUG, plug the lung until it grows, is a new method for treating congenital diaphragmatic hernias. A flexible endoscope is inserted in the mouth of the fetus, and a balloon is passed through the throat then expanded to open the lungs. The balloon is popped and the baby expels it. Congenital cystic adenomatoid malformation (of the lung) (CCAM) surgery is also being performed; however, sometimes the fetuses die before they heal. Sacrococcygeal teratoma, congenital germ cell tumor arising from the presacral area, surgery is being performed too, but it has a mortality rate of 30% to 50% because it is difficult to occlude vessels to prevent huge blood loss when the tumor is resected and it is hard to tell where the tumor ends and the fetus begins. Intrauterine therapy has also been performed for nonlethal disorders, such as spina bifida. The da Vinci robot has been used in the sheep model for intrauterine surgery, with all robotic surgeries being performed satisfactorily. Although fetal surgery is promising, it is not without problems. For example, all pregnancies need to be performed by cesarian delivery because of the port holes, the working space is small, it is difficult to work in a gas or liquid environment, fetal positioning, port size, and membrane damage.