Fetoscopic open neural tube defect repair: Development and refinement of a two-port, carbon dioxide insufflation technique

Michael A. Belfort, William E. Whitehead, Alireza A. Shamshirsaz, Zhoobin H. Bateni, Oluyinka O. Olutoye, Olutoyin A. Olutoye, David G. Mann, Jimmy Espinoza, Erin Williams, Timothy C. Lee, Sundeep G. Keswani, Nancy Ayres, Christopher I. Cassady, Amy R. Mehollin-Ray, Magdalena Sanz Cortes, Elena Carreras, Jose L. Peiro, Rodrigo Ruano, Darrell L. Cass

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks.

Original languageEnglish (US)
Pages (from-to)734-743
Number of pages10
JournalObstetrics and Gynecology
Volume129
Issue number4
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Insufflation
Neural Tube Defects
Carbon Dioxide
Meningomyelocele
Mothers
Hydrocephalus
Hysterotomy
Pregnancy
Spinal Dysraphism
Maternal Age
Patient Selection
Gestational Age
Obstetrics
Uterus
Rupture
Cohort Studies
Retrospective Studies
Demography
Parturition
Membranes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Belfort, M. A., Whitehead, W. E., Shamshirsaz, A. A., Bateni, Z. H., Olutoye, O. O., Olutoye, O. A., ... Cass, D. L. (2017). Fetoscopic open neural tube defect repair: Development and refinement of a two-port, carbon dioxide insufflation technique. Obstetrics and Gynecology, 129(4), 734-743. https://doi.org/10.1097/AOG.0000000000001941

Fetoscopic open neural tube defect repair : Development and refinement of a two-port, carbon dioxide insufflation technique. / Belfort, Michael A.; Whitehead, William E.; Shamshirsaz, Alireza A.; Bateni, Zhoobin H.; Olutoye, Oluyinka O.; Olutoye, Olutoyin A.; Mann, David G.; Espinoza, Jimmy; Williams, Erin; Lee, Timothy C.; Keswani, Sundeep G.; Ayres, Nancy; Cassady, Christopher I.; Mehollin-Ray, Amy R.; Cortes, Magdalena Sanz; Carreras, Elena; Peiro, Jose L.; Ruano, Rodrigo; Cass, Darrell L.

In: Obstetrics and Gynecology, Vol. 129, No. 4, 01.01.2017, p. 734-743.

Research output: Contribution to journalArticle

Belfort, MA, Whitehead, WE, Shamshirsaz, AA, Bateni, ZH, Olutoye, OO, Olutoye, OA, Mann, DG, Espinoza, J, Williams, E, Lee, TC, Keswani, SG, Ayres, N, Cassady, CI, Mehollin-Ray, AR, Cortes, MS, Carreras, E, Peiro, JL, Ruano, R & Cass, DL 2017, 'Fetoscopic open neural tube defect repair: Development and refinement of a two-port, carbon dioxide insufflation technique', Obstetrics and Gynecology, vol. 129, no. 4, pp. 734-743. https://doi.org/10.1097/AOG.0000000000001941
Belfort, Michael A. ; Whitehead, William E. ; Shamshirsaz, Alireza A. ; Bateni, Zhoobin H. ; Olutoye, Oluyinka O. ; Olutoye, Olutoyin A. ; Mann, David G. ; Espinoza, Jimmy ; Williams, Erin ; Lee, Timothy C. ; Keswani, Sundeep G. ; Ayres, Nancy ; Cassady, Christopher I. ; Mehollin-Ray, Amy R. ; Cortes, Magdalena Sanz ; Carreras, Elena ; Peiro, Jose L. ; Ruano, Rodrigo ; Cass, Darrell L. / Fetoscopic open neural tube defect repair : Development and refinement of a two-port, carbon dioxide insufflation technique. In: Obstetrics and Gynecology. 2017 ; Vol. 129, No. 4. pp. 734-743.
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abstract = "OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33{\%}] compared with 1/10 [10{\%}]), and vaginal delivery rates (5/12 [42{\%}] compared with 6/10 [60{\%}]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50{\%}) compared with 1 of 10 (10{\%}), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75{\%}) and 3 of 10 (30{\%}), respectively, and 7 of 12 (58{\%}) compared with 2 of 10 (20{\%}) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks.",
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T1 - Fetoscopic open neural tube defect repair

T2 - Development and refinement of a two-port, carbon dioxide insufflation technique

AU - Belfort, Michael A.

AU - Whitehead, William E.

AU - Shamshirsaz, Alireza A.

AU - Bateni, Zhoobin H.

AU - Olutoye, Oluyinka O.

AU - Olutoye, Olutoyin A.

AU - Mann, David G.

AU - Espinoza, Jimmy

AU - Williams, Erin

AU - Lee, Timothy C.

AU - Keswani, Sundeep G.

AU - Ayres, Nancy

AU - Cassady, Christopher I.

AU - Mehollin-Ray, Amy R.

AU - Cortes, Magdalena Sanz

AU - Carreras, Elena

AU - Peiro, Jose L.

AU - Ruano, Rodrigo

AU - Cass, Darrell L.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks.

AB - OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks.

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