Fetal Endoscopic Tracheal Intubation: Modification of the Fetal Endoscopic Tracheal Intubation Procedure to Establish an Airway in a Fetus with a Congenital Cervical Teratoma

Abstract

Introduction: FETI is a technique where the fetal airway is secured in-utero via intubation by percutaneous endoscopic fetal tracheoscopy under ultrasound guidance. FETI has been described in large fetal neck masses with anatomical airway compression as a feasible airway management strategy and a potential alternative to an EXIT procedure in select cases. Case presentation: This report describes the use of a modified FETI procedure under continuous fetoscopic and ultrasound guidance, in a fetus with a large cervical teratoma causing airway displacement and compression. Following the FETI procedure, an uncomplicated caesarean section was performed. The endotracheal tube was in place at the time of birth and a patent airway was confirmed. Conclusion: The modified FETI procedure described in this report represents another technique that can be used to establish an airway in fetuses with challenging upper airway anatomy, potentially mitigating the risks associated with an EXIT procedure.

Fetal Laryngoscopy and Endoscopic Tracheal Intubation to Avoid ex utero Intrapartum Treatment in the Management of Fetuses with Suspected Airway Obstruction

“…Aside from our case series, other groups have successfully avoided EXIT by replicating our technique in three more cases [14, 15]. One of these groups reported a modification to our percutaneous technique by performing a maternal laparotomy and placing a circumferential retractor to expose the uterine wall for direct trocar introduction, while another group performed the procedure percutaneously but placed the ETT under continuous fetoscopic visualization [15, 17].…”

“…In 2015, we reported a novel fetoscopic procedure to secure fetal airway by fetal endoscopic tracheal intubation (FETI) in a fetus with a neck mass and suspected airway obstruction replacing the EXIT procedure [13]. Following our first publication, 6 additional cases of neck tumors managed with FETI in 4 different fetal centers have been reported [14][15][16][17]. The aim of this publication was to report the outcomes of a single-center prospective cohort of fetuses diagnosed with neck masses and suspected airway obstruction managed with fetal laryngoscopy (FL) for airway evaluation and eventually followed by FETI to avoid EXIT procedures.…”

Indications, Resource Allocation, and Outcomes Associated with Ex-Utero Intrapartum Treatment Procedures: A North American Fetal Therapy Network Survey

“…Likewise, the IPOG study only relied on expert opinion from pediatric otolaryngologists whereas many decisions for appropriateness of EXIT consultation lie in the hands of the MFM specialist and diagnoses beyond micrognathia, head and neck mass, and CHAOS are considered for EXIT. Furthermore, the development of new techniques such as fetal endoscopic tracheal intubation holds promise for future therapeutic options available to the fetus and mother, mitigating the need for EXIT [28][29][30].…”