Minimally invasive fetoscopic interventions: an overview in 2010.

Abstract

BACKGROUND: The availability of high-end endoscopic equipment, microcatheters, miniballoons, tiny laser fibers, and other devices has been instrumental in the development of minimally invasive fetoscopic interventions. These interventions are performed for a spectrum of fetal disease states that progress in severity over the course of gestation and have a huge impact on termination of pregnancy rates, fetal demise, perinatal mortality and morbidity, and long-term prognosis. This report aims to introduce interested readers to these new procedures. METHODS: Fetoscopic interventions such as laser coagulation of pathologic placental vascular connections in twin-to-twin-transfusion-syndrome, fetal biopsies, fetal tracheal balloon occlusion in diaphragmatic hernia, perforation of posterior urethral valves, tracheal decompression in fetal laryngeal atresia, and even coverage of spina bifida aperta can be performed by percutaneous minimally invasive fetoscopic techniques. RESULTS: In contrast to prenatally untreated patients, the majority of patients who underwent fetoscopic interventions followed by state-of-the-art neonatal intensive care experienced improved survival rates and enhanced quality of life. Yet for some patients, significant morbidity from the underlying disease or fetal surgical complications, most often early preterm delivery, persist in postnatal life. CONCLUSION: A growing spectrum of fetal disease states has become amenable to minimally invasive fetoscopic interventions. Sufficient training, an interdisciplinary approach, ethical board supervision, and continued scientific assessment of benefits and risks are important for the success and acceptance of these procedures. Further improvements in fetal selection, surgical techniques, and postnatal management accompanied by the development of specialized devices are desired.