Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I

Amniotic carbon dioxide gas approach

Jose L. Peiro, Cesar G. Fontecha, Rodrigo Ruano, Marielle Esteves, Carla Fonseca, Mario Marotta, Sina Haeri, Michael A. Belfort

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: This study aimed to assess the feasibility of single-access fetal endoscopy (SAFE) for the management of myelomeningocele (MMC) using intrauterine carbon dioxide as a distension medium in a sheep model. Methods: This prospective experimental case-control study investigated 12 lamb fetuses that had a myelomeningocele-like defect surgically created on the 75th day of gestation. Four fetuses remained untreated (control group), and eight fetuses had MMC repair using two fetoscopic approaches with carbon dioxide used to distend the amniotic cavity. A collagen patch was placed over the defect and secured with surgical sealant. Four animals had a two-port fetoscopic procedure, and four animals had SAFE. Clinical and pathologic studies were performed after delivery. Results: This study confirmed the validity of the animal MMC model. None of the control animals was able to stand or walk, and all had a significant defect in the lumbar area with continuous leakage of cerebrospinal fluid, ventriculomegaly, and a Chiari-II malformation. All the treated animals, independently of the number of ports used in the repair, were able to walk and had a closed defect with resolution of the Chiari malformation. Conclusions: The SAFE patch and glue coverage of surgically created fetal MMC is feasible and effective in restoring gross neurologic function in the fetal lamb model.

Original languageEnglish (US)
Pages (from-to)3835-3840
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number10
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Fingerprint

Meningomyelocele
Carbon Dioxide
Endoscopy
Sheep
Gases
Fetus
Adhesives
Nervous System
Case-Control Studies
Collagen
Animal Models
Pregnancy
Control Groups

Keywords

  • Animal model
  • Fetal surgery
  • Fetoscopy
  • Myelomeningocele
  • Single access
  • Spina bifida

ASJC Scopus subject areas

  • Surgery

Cite this

Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I : Amniotic carbon dioxide gas approach. / Peiro, Jose L.; Fontecha, Cesar G.; Ruano, Rodrigo; Esteves, Marielle; Fonseca, Carla; Marotta, Mario; Haeri, Sina; Belfort, Michael A.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 10, 01.10.2013, p. 3835-3840.

Research output: Contribution to journalArticle

Peiro, Jose L. ; Fontecha, Cesar G. ; Ruano, Rodrigo ; Esteves, Marielle ; Fonseca, Carla ; Marotta, Mario ; Haeri, Sina ; Belfort, Michael A. / Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I : Amniotic carbon dioxide gas approach. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 10. pp. 3835-3840.
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abstract = "Background: This study aimed to assess the feasibility of single-access fetal endoscopy (SAFE) for the management of myelomeningocele (MMC) using intrauterine carbon dioxide as a distension medium in a sheep model. Methods: This prospective experimental case-control study investigated 12 lamb fetuses that had a myelomeningocele-like defect surgically created on the 75th day of gestation. Four fetuses remained untreated (control group), and eight fetuses had MMC repair using two fetoscopic approaches with carbon dioxide used to distend the amniotic cavity. A collagen patch was placed over the defect and secured with surgical sealant. Four animals had a two-port fetoscopic procedure, and four animals had SAFE. Clinical and pathologic studies were performed after delivery. Results: This study confirmed the validity of the animal MMC model. None of the control animals was able to stand or walk, and all had a significant defect in the lumbar area with continuous leakage of cerebrospinal fluid, ventriculomegaly, and a Chiari-II malformation. All the treated animals, independently of the number of ports used in the repair, were able to walk and had a closed defect with resolution of the Chiari malformation. Conclusions: The SAFE patch and glue coverage of surgically created fetal MMC is feasible and effective in restoring gross neurologic function in the fetal lamb model.",
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