IMFH | Maternal-Fetal Services | Physician Services | Surgery
When facing a fetal health problem, it is easiest to think of fetal intervention in terms of invasiveness. Open surgery is the most invasive and Fetal Image-Guided Surgery for Intervention or Therapy (FIGS-IT) is the least invasive. Another type, Fetendo fetal surgery, falls in between. Following are basic details about the three types of fetal surgery:
Open Fetal Surgery: In open fetal surgery, the mother is anesthetized, an incision is made in the lower abdomen to expose the uterus, the uterus is opened, the surgical repair of the fetus is completed, the uterus followed by the maternal abdominal wall are closed, and the mother awakened. It is similar to a Cesarean section, except that at the end of the operation the mother is still pregnant. Once performed, it requires Cesarean delivery of this and future pregnancies and may cause preterm labor and preterm delivery.
Fetendo Fetal Surgery: This fetoscopic intervention that was developed in the 1990s to avoid making an incision in the uterus and, hopefully, to minimize preterm labor. The ability to see the fetus through very small endoscopes, which have been available for several decades, were refined to allow surgical manipulation of the fetus with very small instruments guided by direct fetoscopic view on a television monitor. Fetendo intervention can be done either through the mother’s skin (percutaneous) or, in some circumstances, requires a small opening in the mother’s abdomen (mini-laparotomy). Fetendo is particularly useful for treating problems with the placenta, like twin-twin transfusion syndrome, and for looking inside the fetus, for example, to place a balloon in the fetal trachea or deal with obstruction of the fetal bladder.
Fetal Image-Guided Surgery for Intervention or Therapy (FIGS-IT): FIGS-IT is a method of manipulating the fetus without either an incision in the uterus or an endoscopic view inside the uterus. The manipulation is done entirely under real-time, cross-sectional view provided by the sonogram. This is the same sonogram as is used for diagnostic purposes, but in this case, it is used to guide instruments. Like Fetendo, it can be done either through the mother’s skin or, in some cases, with a small opening in the mother’s abdomen. Image-guided intervention can be used for a variety of fetal manipulations including placement of catheter-shunts in the bladder, abdomen or chest, radiofrequency ablation to solve problems with anomalous twins, and even for some cardiac manipulation. It is generally not useful for serious structural problems that require surgery.
