Fetal Surgery

Abstract

The first description of open maternal-fetal surgery for correction of anatomic anomalies by Harrison was published three decades ago (Adzick 2003). At that time, the diagnostic and surgical tools for prenatal treatment of the fetus were just being developed, and the concept of the fetus as a patient was the subject of philosophical and ethical debate. Since then, great progress has been made in the ability to diagnose fetal abnormalities, predict their outcome, and perform surgical interventions when appropriate. The concept of the fetus as a patient has become a standard of care, and the ethical framework for maternal-fetal intervention is well developed (Adzick, Semin Fetal Neonatal Med 15(1):1–8, 2010). While application of open fetal surgery has remained limited to a relatively small number of highly selected fetuses and is practiced in only a few centers, the development of this field has accelerated technological progress in prenatal diagnosis and intervention, led to improved understanding of the pathophysiology and natural history of candidate disorders, allowed comprehensive counseling of parents in centers with focused expertise in fetal anomalies, and driven the evolution of less invasive therapeutic approaches. The purpose of this chapter is to describe the current status of fetal surgical intervention and to speculate regarding future developments in this rapidly evolving field.