Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
Fetal Diagn Ther. 2021;48(11-12):785-793. doi: 10.1159/000519910. Epub 2021 Nov 23.
Iatrogenic preterm premature rupture of the membrane remains the Achille's heel of fetoscopy. The aim of this study was to show in vivo feasibility of fetal membrane (FM) defect sealing by the application of tissue glues with umbrella-shaped receptors.
First, we adapted our previously described ex vivo strategy and evaluated the adhesion strength of different tissue glues, Histoacryl® and Glubran2®, by bonding polytetrafluoroethylene or silicone encapsulated nitinol glue receptor to human FM. Then, we exposed pregnant sheep uterus through a laparotomy and placed a 10-French trocar into the amniotic cavity through which the umbrella-shaped glue receptor (n = 9) was inserted and fixated onto the FM with the tissue glues (n = 8). The tightness of the sealed defects was assessed 4 h post-surgery.
Both tissue glues tested resulted in adhesion of the glue receptors to the FM ex vivo. In vivo, all glue receptors opened in the amniotic cavity (n = 9) and all successfully placed glue receptors sealed the FM defect (n = 8). Four hours post-surgery, 2 treatment sites showed minimal leakage whereas the negative control without glue (n = 1) showed substantial leakage.
This in vivo study confirms that fetoscopically induced FM defects can be sealed by the application of tissue adhesives.
医源性胎膜早破仍然是羊膜镜检查的阿喀琉斯之踵。本研究旨在展示应用具有伞状受体的组织胶来封闭胎儿膜（FM）缺陷的体内可行性。
首先，我们采用了先前描述的离体策略，并通过将聚四氟乙烯或硅酮包裹的镍钛诺胶受体粘合到人 FM 上来评估不同组织胶（Histoacryl®和 Glubran2®）的粘附强度。然后，我们通过剖腹术暴露怀孕绵羊的子宫，并通过 10-French 套管针将伞状胶受体（n=9）插入羊膜腔，并使用组织胶（n=8）将其固定在 FM 上。术后 4 小时评估封闭缺陷的紧密性。
两种测试的组织胶均导致胶受体在离体 FM 上的粘附。在体内，所有胶受体均在羊膜腔中打开（n=9），所有成功放置的胶受体均封闭了 FM 缺陷（n=8）。术后 4 小时，2 个治疗部位仅显示出最小的泄漏，而未使用胶的阴性对照（n=1）则显示出大量泄漏。
这项体内研究证实，羊膜镜检查引起的 FM 缺陷可以通过应用组织粘合剂来封闭。
