Achieving water-tight open spina bifida closure through a novel three-port three-layer fetoscopic repair

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-05-12 DOI:10.1016/j.ajogmf.2025.101697

Robin Bowman MD , Amir Alhajjat MD , Rya Muller BA , Jonathan Scoville MD, MSPH , Aimen Shaaban MD

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引用次数: 0

Abstract

About 3,000 individuals in the United States are born with spina bifida each year. Prenatal surgery for open spina bifida has demonstrated improved neurological and functional outcomes compared to postnatal closure. However, open maternal fetal surgery is associated with increased obstetric complications, such as uterine ruptures and need for cesarean deliveries in the current and any subsequent pregnancies. Minimally invasive fetoscopic approaches were subsequently developed to decrease maternal morbidity from large hysterotomies while preserving the fetal benefits of prenatal repair.

Single and 2-layer fetoscopic closure techniques have been described, but concerns remain regarding the ability to achieve water-tight closure via minimally invasive approaches. Water-tight closure is critical for preventing postoperative complications, particularly cerebrospinal fluid (CSF) leakage and wound dehiscence.

This report describes a novel 3-port, 3-layer fetoscopic repair technique. The accompanying video demonstrates the technique and procedural steps in detail. This method may facilitate higher rates of water-tight dural closure via the fetoscopic approach, potentially reducing postoperative complications.

Abstract Image

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通过一种新型的三孔三层胎儿镜修复术实现开放性脊柱裂水密闭合。

美国每年大约有3000人出生时患有脊柱裂。与产后闭合相比，开放性脊柱裂的产前手术已证明可改善神经和功能预后。然而，开放式母胎手术与产科并发症的增加有关，如子宫破裂和在当前和以后的妊娠中需要剖宫产。微创胎儿镜方法随后发展，以减少大子宫切除术的产妇发病率，同时保留胎儿产前修复的好处。单层和双层胎儿镜闭合技术已经被描述，但是关于通过微创入路实现水密闭合的能力仍然存在问题。水密缝合对于预防术后并发症，特别是脑脊液（CSF）漏出和伤口裂开至关重要。本文介绍一种新颖的三口三层胎儿镜修复技术。随附的视频详细演示了技术和程序步骤。该方法可通过胎儿镜入路提高硬脑膜水密闭合率，潜在地减少术后并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.