Brunner Susanne Eva, Durmaz Lidya-Olgu, Meinzer Andreas, Arp Milena, Krebs Thomas Franz, Bergholz Robert
Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.
Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland.
Children (Basel). 2022 Sep 13;9(9):1377. doi: 10.3390/children9091377.
The aim of this review is to discuss experimental and clinical techniques and interventions of fetal surgery which have been performed minimally invasively by the means of a three-port approach for the fetoscope and instruments for the left and right hand of the surgeon (bimanual minimally invasive fetal surgery).
a print and electronic literature search was performed; the titles and abstracts were screened and included reports were reviewed in a two-step approach. First, reports other than minimally invasive fetal surgery were excluded, then a full text review and analysis of the reported data was performed.
17 reports were included. The heterogeneity of the included reports was high. Although reports on human fetoscopic surgical procedures can be found, most of them do not pick out bimanual fetal surgery as a central theme but rather address interventions applying a fetoscope with a working channel for a laser fiber, needle or flexible instrument. Most reports were on experimentation in animal models, the human application of minimally invasive fetoscopic bimanual surgery is rare and has at best been explored for the prenatal treatment of spina bifida. Some reported bimanual fetoscopic procedures were performed on the exteriorized uterus via a maternal laparotomy and can therefore not be classified as being truly minimally invasive.
our results demonstrate that minimally invasive fetoscopic bimanual surgery is rare, even in animal models, excluding many other techniques and procedures that are loosely termed 'minimally invasive fetal surgery' which we suggest to better label as 'interventions'. Thus, more research on percutaneous minimally invasive bimanual fetoscopic surgery is warranted, with the aim to reduce the maternal, uterine and fetal trauma for correction of congenital malformations.
本综述旨在探讨胎儿手术的实验和临床技术及干预措施，这些手术通过三端口入路以微创方式进行，使用胎儿镜以及外科医生左右手的器械（双手法微创胎儿手术）。
进行了印刷版和电子版文献检索；筛选标题和摘要，并分两步对纳入的报告进行综述。首先，排除非微创胎儿手术的报告，然后对报告数据进行全文综述和分析。
纳入了17份报告。纳入报告的异质性较高。虽然可以找到关于人类胎儿镜手术操作的报告，但其中大多数并未将双手法胎儿手术作为核心主题，而是涉及使用带有激光光纤、针或柔性器械工作通道的胎儿镜的干预措施。大多数报告是关于动物模型实验，微创胎儿镜双手法手术在人类中的应用很少，最多只是探索用于脊柱裂的产前治疗。一些报告的双手法胎儿镜手术是通过母体剖腹术在子宫外进行的，因此不能归类为真正的微创。
我们的结果表明，微创胎儿镜双手法手术很少见，即使在动物模型中也是如此，不包括许多其他被宽松地称为“微创胎儿手术”的技术和程序，我们建议将其更好地标记为“干预措施”。因此，有必要对经皮微创双手法胎儿镜手术进行更多研究，以减少母体、子宫和胎儿的创伤，用于矫正先天性畸形。
