INTRAUTERINE REPAIR OF CLEFT LIP-LIKE DEFECTS IN LAMBS WITH A NOVEL MICROCLIP

Potential for scarless wound healing in fetal surgeries has aroused in terest in fetal repair of malformations such as cleft lip. However, cu rrent protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenet rating, and is well suited for endoscopic use. Using standardized intr auterine surgical techniques, we compared suture versus microclip in t he repair of surgically created cleft lip-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyze d with bilateral cleft lips; the right cleft was repaired by microclip , seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar f ormation after repair by either microclip or suture. The most striking result, however, was in the comparison of intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore , its endoscopic application has the potential for making endoscopic f etal surgery a more viable option.