Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome

Objectives To analyze the current technical approach of percutaneous minimal-access fetoscopic closure of spina bifida aperta (SBA) and provide an overview of its development in ovine and human fetuses. Methods Minimal-access percutaneous fetoscopic closure of SBA was performed at the German Center for Fetal Surgery & Minimal-access Therapy (DZFT) in 51 human fetuses at 21.0-29.1 weeks of gestation (mean age, 23.7 weeks). Various parameters of surgical relevance for the success and safety of the procedure and the early perioperative outcome were analyzed retrospectively. In addition, information from the early clinical cases was examined to determine how this shaped development of the approach. Results Percutaneous minimal-access fetoscopic closure of SBA was performed with a high rate of technical success, regardless of placental or fetal position. All fetuses survived surgery, but there was one very early preterm delivery 1 week after the procedure and this neonate died immediately, from early postoperative chorioamnionitis. Of the 50 surviving fetuses, 44 (88%) were delivered at or beyond 30 weeks and 25 (50%) at or beyond 34 weeks of gestation. There was one neonatal death from an uinsuspected case of trisomy 13 and two infant deaths from Chiari-II malformation. Conclusions Following an adequate learning curve, minimal-access fetoscopic surgery for fetal spina bifida can be performed with a high rate of technical success, regardless of placental position. Copyright c 2014 ISUOG. Published by John Wiley & Sons Ltd.