1. Two-Port Fetoscopic Repair of Myelomeningocele in Fetal Lambs
- Author
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Zoobia Shah, Stéphanie Friszer, Michel Zerah, Nathalie Roux, Jean-Marie Jouannic, Bettina Bessières, Lucie Guilbaud, Federico Di Rocco, Raphaël Vialle, Charles Garabedian, Ferdinand Dhombres, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Service de pédiatrie orthopédique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurochirurgie pédiatrique [CHU Necker], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP]
- Subjects
Embryology ,medicine.medical_specialty ,Meningomyelocele ,medicine.medical_treatment ,Gestational Age ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Suture (anatomy) ,Pregnancy ,Medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Fetal loss ,Spina bifida ,Sheep, Domestic ,Fetal surgery ,Fetus ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,030219 obstetrics & reproductive medicine ,business.industry ,Two-port fetoscopy ,Fetoscopy ,Suture Techniques ,Obstetrics and Gynecology ,Fetal lambs ,Insufflation ,General Medicine ,Carbon Dioxide ,medicine.disease ,Surgery ,Disease Models, Animal ,Pediatrics, Perinatology and Child Health ,Open repair ,Feasibility Studies ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Female ,Myelomeningocele ,business ,Premature rupture of membranes ,Live Birth - Abstract
Objective: The aim of this study was to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) repair with a running single suture using a 2-port access in the sheep model. Methods: Eighteen fetuses underwent surgical creation of a MMC defect at day 75. Fetuses were then randomized into 3 groups. Four fetuses remained untreated (control group). In the other 14 fetuses, a prenatal repair was performed at day 90: 7 fetuses had an open repair (oMMC), and 7 fetuses had a fetoscopic repair (fMMC) using a single-layer running suture through a 2-port access. Lambs were sacrificed at term, and histological examinations were performed. Results: Hindbrain herniation was observed in all live lambs in the control group. A complete closure of the defect was achieved in all the lambs of the fMMC group. A complete healing of the defect and no hindbrain herniation were observed in all live lambs of the oMMC and fMMC groups. The durations of surgeries were not statistically different between the oMMC and the fMMC groups (60 vs. 53 min, p = 0.40), as was the risk of fetal loss (fMMC: 1/7, oMMC: 3/7, p = 0.56). Discussion: Fetoscopic repair of MMC can be performed using a single-layer running suture through a 2-port access and may be promising to reduce the risk of premature rupture of membranes.
- Published
- 2017
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