SINGLE-PORT TRACHEOSCOPIC SURGERY IN THE FETAL LAMB

Background/Purpose: Endoscopic fetal surgery could help avoid many of the problems associated with open fetal surgery, but the use of multip le ports may be too traumatic to the membranes. The authors describe a single-port technique of tracheoscopic surgery in the fetus. Methods: Time-dated pregnant ewes (95 to 105 days; term, 145 days) underwent m idline laparotomy under general halothane anesthesia. A 5-mm-diameter balloon-tipped cannula was introduced in the uterus by Seldinger techn ique. A 1.2-mm semirigid mini-endoscope, fitted inside a 9F, 20 degree s curved sheath, was introduced under continuous, low-pressure irrigat ion, inside the fetus' mouth, and advanced into the trachea. Results: Endotracheal procedures, including temporary (n = 11) and permanent ba lloon tracheal occlusion (n = 30) and placement of a barbed guide wire for endotracheal occlusion device insertion (n = 12), were performed by introducing a l-mm diameter instrument alongside the telescope. The se were successfully performed in 52 of the 53 fetuses. The rigidity o f the telescope allowed controlled access to the pharynx; its curve al lowed full tracheobronchial endoscopy with the fetus in utero. Conclus ions: The present technique marries the control and optical quality of a rigid endoscope with the physiological curve only a flexible instru ment could offer until now. The types of procedures performed with thi s technique illustrate its potential as a research tool; the size (1.2 -mm diameter), shape, and optical qualities of the telescope should ma ke clinical applications possible. J Pediatr Surg 33:918-920. Copyrigh t (C) 1998 by W.B. Saunders Company.