Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program

Abstract

Open spina bifida (OSB) is a congenital, non-lethal malformation with multifactorial etiology. Fetal therapy can be offered under certain conditions to parents after accurate prenatal diagnostic and interdisciplinary counseling. Since the advent of prenatal OSB surgery, various modifications of the original surgical techniques have evolved, including laparotomy-assisted fetoscopic repair. After a two-year preparation time, the team at the University of Giessen and Marburg (UKGM) became the first center to provide a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach in the German-speaking area. We point out that under the guidance of experienced centers and by intensive multidisciplinary preparation and training, a previously described and applied technique could be transferred to a different setting.

Keywords: fetal therapy; fetoscopic repair; open spina bifida; standardized training.

Figure 1

Interdisciplinary team at UKGM: 13 departments are involved in the care of OSB. The center offers the complete spectrum of pre-, peri-, and postnatal care for OSB.

Figure 2

UKGM’s own long-term follow-up: parents are asked to attend regular neuropediatric checkups, MRI imaging is dependent on the child’s clinical condition, but at least once a year. Children are followed up until 72 months of age in a standardized protocol.

Figure 3

(A): Multidisciplinary team during laparotomy-assisted fetoscopic approach (B): Exteriorized uterus with 3 ports (C): Fetoscopic view on Myelomeningocele (D): Uterus after port removal.