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Open Fetal Surgery is a topic covered in the Pediatric Surgery NaT.

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Assessment

Championed by Michael Harrison, the inception of open fetal surgery dates back to 1978 at the University of California, San Francisco but it was not until 1983 that the first human open fetal intervention was performed. This was a case of lower urinary tract obstruction managed by open ureterostomies [1]. Fetal surgery poses a unique challenge as it involves two patients: the mother and her fetus. This particular scenario has only been observed in transplantation from a living donor. Because of the risk to the mother (who derives no direct benefit from fetal surgery) open fetal surgery was initially performed only for lethal conditions. Recently, the indications have been expanded to include myelomeningocele as a randomized controlled trial showed decreased morbidity associated with fetal intervention.

The goal of fetal surgery is to improve the health of the future child. To reach this goal there is risk imposed upon the mother. Due to the inherent ethical issues associated with the balance of fetal and maternal health, a symposium of fetal experts convened and developed five criteria that must be met for fetal surgery to be be performed [2]. These criteria are adhered to regardless of the type or invasiveness of the intervention which can range from percutaneous radiofrequency ablation to fetoscopy to open fetal surgery and ex utero intrapartum treatment.

Criteria for fetal surgery

An accurate diagnosis and staging is possible with the exclusion of associated anomalies.

The natural history of the disease is documented and prognosis is established.

Currently, there is no effective postnatal therapy.

In utero surgery is proven feasible in animal models reversing deleterious effects of the condition.

There have been interventions performed in specialized multidisciplinary fetal treatment centers within strict protocols and approval of the local ethics committee with informed consent of the mother or parents.

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Last updated: July 12, 2018

Citation

Koehler, Shannon, et al. "Open Fetal Surgery." Pediatric Surgery NaT, American Pediatric Surgical Association, 2018. APSA Webapp, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829166/all/Open_Fetal_Surgery.
Koehler S, Wagner AJ, Marwan R. Open Fetal Surgery. In: Waldhausen J, Powell D, Hirschl R, eds. Pediatric Surgery NaT. American Pediatric Surgical Association; 2018. https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829166/all/Open_Fetal_Surgery. Accessed May 26, 2019.
Koehler, S., Wagner, A. J., & Marwan, R. (2018). Open Fetal Surgery. In Waldhausen, J., Powell, D., & Hirschl, R. (Eds.), Pediatric Surgery NaT. Available from https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829166/all/Open_Fetal_Surgery
Koehler S, Wagner AJ, Marwan R. Open Fetal Surgery [Internet]. In: Waldhausen J, Powell D, Hirschl R, editors. Pediatric Surgery NaT. American Pediatric Surgical Association; 2018. [cited 2019 May 26]. Available from: https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829166/all/Open_Fetal_Surgery.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Open Fetal Surgery ID - 829166 A1 - Koehler,Shannon, AU - Wagner,Amy,MD AU - Marwan,Rony,MD ED - Waldhausen,John, ED - Powell,David, ED - Hirschl,Ron, Y1 - 2018/07/12/ BT - Pediatric Surgery NaT UR - https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829166/all/Open_Fetal_Surgery PB - American Pediatric Surgical Association DB - APSA Webapp DP - Unbound Medicine ER -