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Search Results (7)

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Keywords = fetoscopy surgery

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11 pages, 11221 KiB  
Case Report
Minimally Invasive Fetoscopic Resection of Life-Threatening Amniotic Band Constrictions in a Human Fetus at 22 + 2 Weeks of Gestation Complicated by Subtotal Chorioamniotic Separation and Partial Placental Abruption
by Nadja Riehle, Oliver Nowak, Leila Messroghli, Samantha Wakerlin, Thomas Schaible and Thomas Kohl
Children 2025, 12(1), 20; https://doi.org/10.3390/children12010020 - 26 Dec 2024
Viewed by 743
Abstract
Amniotic band syndrome is a constrictive phenomenon in fetal development that can provoke limb autoamputation, malformation, trunk division, and umbilical cord strangulation. The latter two complications will ultimately lead to fetal demise if left untreated. If detected early enough, select cases may benefit [...] Read more.
Amniotic band syndrome is a constrictive phenomenon in fetal development that can provoke limb autoamputation, malformation, trunk division, and umbilical cord strangulation. The latter two complications will ultimately lead to fetal demise if left untreated. If detected early enough, select cases may benefit from prenatal resection of the amniotic bands, thus preventing amputation and fetal death. Yet, especially in the presence of complete chorioamniotic separation, these procedures are rare, technically difficult, and not without significant risk. Objectives: The purpose of this report is to present the surgical technique and outcome of a challenging percutaneous fetoscopic intervention in a human fetus with amniotic band constrictions of a fetal thigh, retroplacental hematoma, partial placental abruption, subtotal chorioamniotic separation, and multiple amniotic bands encircling the umbilical cord. Methods: Minimally invasive, fetoscopic surgery to salvage the fetal life and lower leg was performed at 22 + 2 weeks of gestation under general maternofetal anesthesia. Results: Total resection of all amniotic bands was achieved, notwithstanding the aforementioned challenges. No surgical complications were observed. Despite preterm delivery at 25 + 4 weeks of gestation, the postnatal experience for the infant was favorable and uncomplicated as it furthermore benefitted from neonatal intensive care. At almost three years of age, the child remains healthy and demonstrates normal function of the formerly constricted leg. Conclusions: Our case shows that the combination of tested percutaneous fetoscopic techniques, high-risk obstetrics, and modern neonatology can overcome multiple obstacles in order to save a fetal patient stuck in a near-hopeless situation. Full article
(This article belongs to the Special Issue Prenatal Diagnosis—Postnatal Implications)
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13 pages, 2002 KiB  
Systematic Review
Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis
by Henrique Provinciatto, Maria Esther Barbalho, Edward Araujo Júnior, Rogelio Cruz-Martínez, Pankaj Agrawal, Gabriele Tonni and Rodrigo Ruano
J. Clin. Med. 2024, 13(12), 3572; https://doi.org/10.3390/jcm13123572 - 18 Jun 2024
Cited by 2 | Viewed by 1547
Abstract
Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters [...] Read more.
Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47–9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76–13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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8 pages, 10666 KiB  
Case Report
Case Report: Fetoscopic Laparoschisis (FETO-LAP)—A New Therapeutic Route to Explore for Fetuses with Severe Diaphragmatic Hernias
by Thomas Kohl, Nadja Riehle, Leila Messroghli, Sibylle Maus, Christiane Otto, Michaela Klinke, Richard Martel, Grietje Beck, Michael Boettcher and Thomas Schaible
Children 2023, 10(11), 1758; https://doi.org/10.3390/children10111758 - 30 Oct 2023
Cited by 1 | Viewed by 1923
Abstract
Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic [...] Read more.
Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic laparoschisis (FETO-LAP). Case summary: A life-threatening left diaphragmatic hernia (liver-up; o/e LHR of ≤25%; MRI lung volume ≤ 20%) was observed in a human fetus at 34 weeks of gestation. After counselling the mother about the high risks of postnatal demise if left untreated, the expected limitations of fetoscopic tracheal occlusion (FETO), and the previously untested option of combining FETO with fetoscopic laparoschisis, i.e., partial removal of the herniated bowel from the fetal chest (FETO-LAP), she consented to the latter novel treatment approach. FETO-LAP was performed at 36 + 5 weeks of gestation under general maternofetal anesthesia. Mother and fetus tolerated the procedure well. The neonate was delivered and the balloon removed on placental support at 37 + 2 weeks of gestation. On ECMO, a rapid increase in tidal volume was seen over the next eight days. Unfortunately, after this period, blood clots obstructed the ECMO circuit and the neonate passed away. Discussion: This seminal case shows that in a fetus with severe left diaphragmatic hernia, partial removal of the herniated organs from the fetal chest is not only possible by minimally invasive fetoscopic techniques but also well tolerated. As the effect of FETO alone is limited in saving severely affected fetuses, combining FETO with fetoscopic laparoschisis (FETO-LAP) offers a new therapeutic route with multiple, potentially life-saving implications. Full article
(This article belongs to the Section Pediatric Surgery)
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9 pages, 2417 KiB  
Brief Report
Placental Vessel Segmentation Using Pix2pix Compared to U-Net
by Anouk van der Schot, Esther Sikkel, Marèll Niekolaas, Marc Spaanderman and Guido de Jong
J. Imaging 2023, 9(10), 226; https://doi.org/10.3390/jimaging9100226 - 16 Oct 2023
Cited by 4 | Viewed by 2244
Abstract
Computer-assisted technologies have made significant progress in fetoscopic laser surgery, including placental vessel segmentation. However, the intra- and inter-procedure variabilities in the state-of-the-art segmentation methods remain a significant hurdle. To address this, we investigated the use of conditional generative adversarial networks (cGANs) for [...] Read more.
Computer-assisted technologies have made significant progress in fetoscopic laser surgery, including placental vessel segmentation. However, the intra- and inter-procedure variabilities in the state-of-the-art segmentation methods remain a significant hurdle. To address this, we investigated the use of conditional generative adversarial networks (cGANs) for fetoscopic image segmentation and compared their performance with the benchmark U-Net technique for placental vessel segmentation. Two deep-learning models, U-Net and pix2pix (a popular cGAN model), were trained and evaluated using a publicly available dataset and an internal validation set. The overall results showed that the pix2pix model outperformed the U-Net model, with a Dice score of 0.80 [0.70; 0.86] versus 0.75 [0.0.60; 0.84] (p-value < 0.01) and an Intersection over Union (IoU) score of 0.70 [0.61; 0.77] compared to 0.66 [0.53; 0.75] (p-value < 0.01), respectively. The internal validation dataset further validated the superiority of the pix2pix model, achieving Dice and IoU scores of 0.68 [0.53; 0.79] and 0.59 [0.49; 0.69] (p-value < 0.01), respectively, while the U-Net model obtained scores of 0.53 [0.49; 0.64] and 0.49 [0.17; 0.56], respectively. This study successfully compared U-Net and pix2pix models for placental vessel segmentation in fetoscopic images, demonstrating improved results with the cGAN-based approach. However, the challenge of achieving generalizability still needs to be addressed. Full article
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10 pages, 1963 KiB  
Case Report
Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
by Agnieszka Pastuszka, Mateusz Zamłyński, Tomasz Horzelski, Jacek Zamłyński, Ewa Horzelska, Iwona Maruniak-Chudek, Adrianna Marzec, Justyna Paprocka, Patrycja Gazy, Tomasz Koszutski and Anita Olejek
Diagnostics 2022, 12(12), 2978; https://doi.org/10.3390/diagnostics12122978 - 28 Nov 2022
Cited by 1 | Viewed by 3977
Abstract
Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications [...] Read more.
Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC. Full article
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12 pages, 1289 KiB  
Review
Minimally Invasive Bimanual Fetal Surgery—A Review
by Susanne Eva Brunner, Lidya-Olgu Durmaz, Andreas Meinzer, Milena Arp, Thomas Franz Krebs and Robert Bergholz
Children 2022, 9(9), 1377; https://doi.org/10.3390/children9091377 - 13 Sep 2022
Cited by 2 | Viewed by 2455
Abstract
Background: The aim of this review is to discuss experimental and clinical techniques and interventions of fetal surgery which have been performed minimally invasively by the means of a three-port approach for the fetoscope and instruments for the left and right hand of [...] Read more.
Background: The aim of this review is to discuss experimental and clinical techniques and interventions of fetal surgery which have been performed minimally invasively by the means of a three-port approach for the fetoscope and instruments for the left and right hand of the surgeon (bimanual minimally invasive fetal surgery). Methods: a print and electronic literature search was performed; the titles and abstracts were screened and included reports were reviewed in a two-step approach. First, reports other than minimally invasive fetal surgery were excluded, then a full text review and analysis of the reported data was performed. Results: 17 reports were included. The heterogeneity of the included reports was high. Although reports on human fetoscopic surgical procedures can be found, most of them do not pick out bimanual fetal surgery as a central theme but rather address interventions applying a fetoscope with a working channel for a laser fiber, needle or flexible instrument. Most reports were on experimentation in animal models, the human application of minimally invasive fetoscopic bimanual surgery is rare and has at best been explored for the prenatal treatment of spina bifida. Some reported bimanual fetoscopic procedures were performed on the exteriorized uterus via a maternal laparotomy and can therefore not be classified as being truly minimally invasive. Discussion: our results demonstrate that minimally invasive fetoscopic bimanual surgery is rare, even in animal models, excluding many other techniques and procedures that are loosely termed ‘minimally invasive fetal surgery’ which we suggest to better label as ‘interventions’. Thus, more research on percutaneous minimally invasive bimanual fetoscopic surgery is warranted, with the aim to reduce the maternal, uterine and fetal trauma for correction of congenital malformations. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery)
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22 pages, 650 KiB  
Review
Fetal Surgery for Gastroschisis—A Review with Emphasis on Minimally Invasive Procedures
by Lidya-Olgu Durmaz, Susanne Eva Brunner, Andreas Meinzer, Thomas Franz Krebs and Robert Bergholz
Children 2022, 9(3), 416; https://doi.org/10.3390/children9030416 - 15 Mar 2022
Cited by 7 | Viewed by 4734
Abstract
(1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, [...] Read more.
(1) Background: The morbidity of gastroschisis is defined by exposure of unprotected intestines to the amniotic fluid leading to inflammatory damage and consecutive intestinal dysmotility, the viscero-abdominal disproportion which results in an abdomen too small to incorporate the herniated and often swollen intestine, and by associated pathologies, such as in complex gastroschisis. To prevent intestinal damage and to provide for growth of the abdominal cavity, fetal interventions such as amnio exchange, gastroschisis repair or covering have been evaluated in several animal models and human trials. This review aims to evaluate the reported techniques for the fetal treatment of gastroschisis by focusing on minimally invasive procedures. (2) Methods: We conducted a systematic database search, quality assessment and analyzed relevant articles which evaluate or describe surgical techniques for the prenatal surgical management of gastroschisis in animal models or human application. (3) Results: Of 96 identified reports, 42 eligible studies were included. Fetal interventions for gastroschisis in humans are only reported for EXIT procedures and amnio exchange. In animal models, particularly in the fetal sheep model, several techniques of open or minimally invasive repair of gastroschisis or covering the intestine have been described, with fetoscopic covering being the most encouraging. (4) Discussion: Although some promising minimally invasive techniques have been demonstrated in human application and animal models, most of them are still associated with relevant fetal morbidity and mortality and barely appear to be currently applicable in humans. Further research on specific procedures, instruments and materials is needed before any human application. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery)
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