Calvano C J, Moran M E, Mehlhaff B A, Reddy P P, Mandell J
Division of Urology, Albany Medical College, New York 12208, USA.
JSLS. 1998 Jul-Sep;2(3):227-33.
Prenatal interventions may prevent some sequelae of congenital anomalies, yet open fetal surgery is limited by pre-term labor. We are developing amnioscopic strategies to reduce risks for in utero surgery.
Seven fetal sheep were accessed percutaneously under ultrasound guidance, via maternal laparoscopy/transuterine trocars, or via laparoscopically assisted partial uterine exteriorization (mini-hysterotomy). Three fetal immobilization methods were investigated: 2 mm grasping forceps, 2-0 absorbable Roeder loop lasso, and detachable metal T-fasteners.
Percutaneous access with 2 mm trocars required accessible amniotic fluid pockets. The laparoscopically assisted method enabled 5 mm trocar placement under direct fetal visualization. Mini-hysterotomy avoided trocars and was leak-proof. 2 mm graspers enabled fetal manipulation with repeatable applications. Roeder loop sutures were not readily repositioned, and required two 3 mm or larger trocars. T-fasteners were easily deployed into fetal skin via the self-contained needle applicator with minimal hemorrhage. Cutaneous marks were present immediately from the grasper and T-fastener, but not at postoperative day 10. The Roeder loop produced no observable effects. All devices demonstrated adequate intrauterine performance.
Minimally invasive fetal surgery promises to lower maternal-fetal risks. All strategies permitted prolonged amnioscopy and fetal manipulation. The 2 mm grasper was easiest to use, producing no observable lasting trauma.
产前干预或许可预防先天性异常的一些后遗症，但开放性胎儿手术受早产限制。我们正在研发羊膜镜检查策略以降低宫内手术风险。
通过母体腹腔镜检查/经子宫套管针、或通过腹腔镜辅助部分子宫外置术（微型子宫切开术），在超声引导下经皮对7只胎羊进行手术。研究了三种胎儿固定方法：2毫米抓钳、2-0可吸收Roeder环套索、以及可拆卸金属T形紧固件。
使用2毫米套管针经皮穿刺需要有可触及的羊水囊。腹腔镜辅助方法可在直接观察胎儿的情况下放置5毫米套管针。微型子宫切开术无需套管针且防漏。2毫米抓钳可进行可重复操作的胎儿操作。Roeder环缝线不易重新定位，且需要两个3毫米或更大的套管针。T形紧固件通过自带的针式施药器可轻松植入胎儿皮肤，出血极少。抓钳和T形紧固件立即留下皮肤痕迹，但术后第10天未留下痕迹。Roeder环未产生可观察到的影响。所有器械在宫内均表现良好。
微创胎儿手术有望降低母婴风险。所有策略均允许长时间进行羊膜镜检查和胎儿操作。2毫米抓钳最易于使用，未产生可观察到的持久创伤。
