Percutaneous minimal‐access fetoscopic surgery for myelomeningocele – not so minimal!

Flake, Alan W.

doi:10.1002/uog.14673

Cited by 29 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The reason for the persistently high PPROM rates remains unclear. It seems tempting to relate that to the need for multiple trocars, as previously observed for multiple port cord occlusion [27,36,50,51,52,53]. Also the size of the puncture sites may play a role.…”

Section: Discussionmentioning

confidence: 99%

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

166

View full text Add to dashboard Cite

Objective: To compare outcomes of fetoscopic spina bifida aperta repair (FSBAR) with the results of the open approach (OSBAR) as in the Management Of Myelomeningocele Study (MOMS). Methods: This was a systematic comparison of reports on FSBAR with data from the MOMS (n = 78). Inclusion criteria were studies of spina bifida aperta patients who underwent FSBAR and were followed for ≥12 months. Primary outcome was perinatal mortality. Secondary outcomes included operative, maternal, fetal, neonatal and infant outcomes. Results: Out of 16 reports, we included 5 from 2 centers. Due to bias and heterogeneity, analysis was restricted to two overlapping case series (n = 51 and 71). In those, FSBAR was technically different from OSBAR, had comparable perinatal mortality (7.8 vs. 2.6%, p = 0.212) and shunt rate at 12 months (45 vs. 40%, p = 0.619), longer operation time (223 vs. 105 min, p < 0.001), higher preterm prelabor membrane rupture rate (84 vs. 46%, p < 0.001), earlier gestational age at birth (32.9 vs. 34.1 weeks, p = 0.03), higher postnatal reoperation rate (28 vs. 2.56%, p < 0.001) and absence of uterine thinning or dehiscence (0 vs. 36%, p < 0.001). Functional outcomes were not available. Conclusion: FSBAR utilizes a different neurosurgical technique, takes longer to complete, induces more prematurity, requires additional postnatal procedures, yet has a comparable shunt rate and is not associated with uterine thinning or dehiscence. Long-term functional data are awaited.

show abstract

Section: Discussionmentioning

confidence: 99%

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

166

View full text Add to dashboard Cite

show abstract

“…9 This approach is still evolving; hence, the debate on clinical implementation, exact technique, and current outcomes is ongoing. [89][90][91] Our recent systematic review and meta-analysis has shown that the learning curve of fMMC surgery, defined by fetal safety and efficacy, is significant, regardless of the approach (Table S2). While 35 consecutive cases via standard open approach are needed to reach competency, at least 56 consecutive percutaneous fetoscopic cases are required.…”

Section: Minimally Invasive Approach To Fmmc Surgerymentioning

confidence: 99%

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

Danzer

Joyeux

Flake

et al. 2019

Develop Med Child Neuro

View full text Add to dashboard Cite

Fetal myelomeningocele (fMMC) closure (spina bifida aperta) has become a care option for patients that meet inclusion criteria, but it is clear that fetal intervention, while improving outcomes, is not a cure. This review will: (1) focus on the rationale for fMMC surgery based on preclinical studies and observations that laid the foundation for human pilot studies and a randomized controlled trial; (2) summarize important clinical outcomes; (3) discuss the feasibility, efficacy, and safety of recent developments in fetal surgical techniques and approaches; and (4) highlight future research directions. Given the increased risk of maternal and fetal morbidity associated with prenatal intervention, accompanied by the increasing number of centres performing interventions worldwide, teams involved in the care of these patients need to proceed with caution to maintain technical expertise, competency, and patient safety. Ongoing assessment of durability of the benefits of fMMC surgery, as well as additional refinement of patient selection criteria and counselling, is needed to further improve outcomes and reduce the risks to the mother and fetus. What this paper adds High‐quality prospective studies are needed to broaden the indication for fetal surgery in the general myelomeningocele population. Innovative minimally invasive approaches have had promising results, yet lack comprehensive and robust experimental or clinical evaluation. Important information to help families make informed decisions regarding fetal surgery for myelomeningocele is provided.

show abstract

“…Heavy problems, such as fetal demise, strong trocar site bleeding that required termination of an uncompleted operation, incomplete or even failed patch coverage, oligohydramnios due to port site leaks, premature rupture of membranes, chorioamnionitis, and prematurity as low as 28 weeks have been encountered by groups using the percutaneous approach. [67][68][69] On the contrary, the technique where the uterus is exposed by a laparotomy allows port site control, a noninvasive positioning and fixation of the fetus, and a safe access also in patients with anterior placenta. 63 While in open fetal OSB surgery, the repair is done as postnatally with a three-layer closure (see earlier), the fetoscopic approach adopts simply patches or a direct skin closure.…”

Section: The Fetoscopic Repairmentioning

confidence: 99%

Intrauterine Treatment of Spina Bifida

Mazzone¹,

Meuli²

2016

Donald School Journal of Ultrasound in Obstetrics and Gynecology

View full text Add to dashboard Cite

Prenatal repair for open spina bifida (OSB) represents nowadays a valid therapeutic option that must be considered whenever a fetus is diagnosed with this severe congenital malformation. However, a judicious weighing of the benefits obtained by fetal surgery against the risks is necessary for every individual case. This article provides the background information that is needed to accomplish that. It describes the evolution of fetal surgery for spina bifida, its benefits and risks, and the different techniques used today.

show abstract

Percutaneous minimal‐access fetoscopic surgery for myelomeningocele – not so minimal!

Cited by 29 publications

References 12 publications

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

Intrauterine Treatment of Spina Bifida

Contact Info

Product

Resources

About