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Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I: amniotic carbon dioxide gas approach

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Abstract

Background

This study aimed to assess the feasibility of single-access fetal endoscopy (SAFE) for the management of myelomeningocele (MMC) using intrauterine carbon dioxide as a distension medium in a sheep model.

Methods

This prospective experimental case-control study investigated 12 lamb fetuses that had a myelomeningocele-like defect surgically created on the 75th day of gestation. Four fetuses remained untreated (control group), and eight fetuses had MMC repair using two fetoscopic approaches with carbon dioxide used to distend the amniotic cavity. A collagen patch was placed over the defect and secured with surgical sealant. Four animals had a two-port fetoscopic procedure, and four animals had SAFE. Clinical and pathologic studies were performed after delivery.

Results

This study confirmed the validity of the animal MMC model. None of the control animals was able to stand or walk, and all had a significant defect in the lumbar area with continuous leakage of cerebrospinal fluid, ventriculomegaly, and a Chiari-II malformation. All the treated animals, independently of the number of ports used in the repair, were able to walk and had a closed defect with resolution of the Chiari malformation.

Conclusions

The SAFE patch and glue coverage of surgically created fetal MMC is feasible and effective in restoring gross neurologic function in the fetal lamb model.

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Disclosures

Jose L. Peiro, Cesar G. Fontecha, Rodrigo Ruano, Marielle Esteves, Carla Fonseca, Mario Marotta, Sina Haeri, and Michael A. Belfort have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d’Hebron, Edifici Infantil, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Jose L. Peiro, Cesar G. Fontecha, Marielle Esteves, Carla Fonseca & Mario Marotta

  2. Department of Obstetrics and Gynecology, Texas Children’s Fetal Center, Baylor College of Medicine, Houston, TX, USA

    Rodrigo Ruano, Sina Haeri & Michael A. Belfort

Authors
  1. Jose L. Peiro
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  2. Cesar G. Fontecha
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  3. Rodrigo Ruano
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  4. Marielle Esteves
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  5. Carla Fonseca
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  6. Mario Marotta
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  7. Sina Haeri
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  8. Michael A. Belfort
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Corresponding author

Correspondence to Jose L. Peiro.

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Peiro, J.L., Fontecha, C.G., Ruano, R. et al. Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I: amniotic carbon dioxide gas approach. Surg Endosc 27, 3835–3840 (2013). https://doi.org/10.1007/s00464-013-2984-6

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  • DOI: https://doi.org/10.1007/s00464-013-2984-6

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