Fetoscopy.

Fetoscopy involves the application of microlaparoscopic technology to fetal diagnosis and therapeutic intervention. Though fetoscopy presents many potential advantages over open fetal surgery, the primary one is that of decreased procedure-induced preterm labor and fetal loss from preterm delivery. The small uterine puncture sites required for fetoscopic surgery should, in theory, obviate the morbidity of a large hysterotomy. Fetoscopic instrumentation is small by design, but this has not limited the breadth of the interventional spectrum, because creative applications have been used for the treatment of twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, hydronephrosis, congenital diaphragmatic hernia, fetal tumors, and myelomeningocele. This article examines the fetoscopic experience for these applications, involving over 150 cases. The results for many procedures are auspicious and will improve as further operative experience and newer fetoscopic technologies become available. However, as with any novel technology, responsible application must involve careful experimentation and an analysis of potential maternal and fetal benefits.