Port insertion and removal techniques to minimize premature rupture of the membranes in endoscopic fetal surgery

Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

“…There was one case of PPROM within 3 weeks of the procedure. However, the overall gestational age at delivery in their series was 28.4 weeks with a procedure-to-delivery interval of 6.5 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] weeks. This gestational age at delivery was 3-4 weeks lower than in other published series.…”

“…Finally, the animal membranes are vascular, a characteristic lacking in human membranes and that prevents healing 4 . Chang et al 15 published the only other human study of placement of a gelatin sponge to reduce the rate of iPPROM after fetoscopy. The study consisted of 27 patients and no controls, with a mean gestational age at procedure of 21.3 weeks.…”

Fetal Surgery: Coming to a Center Near You?

“…Furthermore, various techniques to reduce chorioamniotic membrane separation at the port sites are being developed. 9 Fetuses treated in the Eurofetus study had a median gestational age at delivery of 33.2 weeks compared with a mean gestational age of 30.8 weeks in the Harrison study. Although the Eurofetus study showed marked improvement in survival compared with a control group, this survival rate is below what many centers in the United States experience even with standard postnatal care.…”

The use of endoscopy in fetal medicine

“…This cannula enables the surgeon to change instruments during the intervention and, in theory, reduces membrane friction, however, at the expense of a larger diameter. The port can be inserted into the amniotic cavity using a stabbing trocar or over a guide wire and dilator (Seldinger technique) [29,[38][39][40]. Alternatively, the fetoscope sheath can be inserted directly, using a pyramidal obturator within.…”

“…Fetal hydrops and placentomegaly are accepted indicators for fetal intervention [112][113][114][115]. Causative approaches comprise open fetal tumor resection or debulking, which was published in eight cases with a mean GA of 28 weeks (range [26][27][28][29] and four survivors [116][117][118]. There is casuistic experience with less-invasive interventions such as thermocoagulation, radiofrequency ablation, embolization, and laser surgery [115,[119][120][121].…”