Laboratory for Cell and Tissue Engineering, Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.
Laboratory for Cell and Tissue Engineering, Department of Obstetrics, University Hospital Zurich, Zurich,
Fetal Diagn Ther. 2019;45(2):102-110. doi: 10.1159/000487393. Epub 2018 Jun 19.
The benefits of endoscopic fetal surgery are deteriorated by the high risk of iatrogenic preterm prelabor rupture of fetal membranes (iPPROM). While previous studies have reported good sealing candidates to prevent membrane rupture, the delivery of these materials to the location of membrane puncture remains unsolved.
We describe an approach to apply sealing materials onto the amnion through the fetoscopy port. We developed a device composed of an umbrella-shaped polyester coated nitinol mesh and an applicator. The spontaneously unfolding umbrella is pushed through the port, pulled against the amnion, and glued onto the amnion defect site. We tested the adhesion strength of multiple glues and tested the feasibility and reproducibility of this fetal membrane sealing approach in an ex vivo model.
The umbrella unfolded and was well positioned in all tests (n = 18). When applied via the fetoscopy port, umbrellas were successfully glued onto the fetal membrane, and all of them completely covered the defect (n = 5). The mean time needed for the whole procedure was 3 min.
This study is a proof of concept presenting a potential future solution for the precise local application of bioadhesives for the prevention of iPPROM.
内镜胎儿手术的益处因医源性早产胎膜早破（iPPROM）的高风险而受损。虽然之前的研究已经报道了一些良好的密封候选物来预防膜破裂，但这些材料输送到膜穿刺部位的问题仍未解决。
我们描述了一种通过胎儿镜端口将密封材料应用于羊膜的方法。我们开发了一种由伞状聚酯涂层镍钛诺网和施药器组成的装置。自动展开的伞通过端口推动，紧贴羊膜，并粘在羊膜缺陷部位。我们测试了多种胶水的粘附强度，并在离体模型中测试了这种胎儿膜密封方法的可行性和可重复性。
在所有测试中（n = 18），伞均成功展开并定位良好。通过胎儿镜端口应用时，伞成功地粘在羊膜上，并且所有伞都完全覆盖了缺陷（n = 5）。整个过程平均需要 3 分钟。
本研究是一个概念验证，提出了一种未来用于精确局部应用生物粘合剂预防 iPPROM 的潜在解决方案。
