Perspectives of operative endoscopy in fetal medicine

In this review the indications, techniques, results and perspectives of ope rative fetoscopy are described and discussed. Prenatal invasive therapy is indicated if postnatal therapy comes too late and fetal disease may lead to irreversible damage or death if it is left untreated. Potential candidates for intrauterine surgery are pregnancies with the following problems: diap hragmatic hernia, infravesical obstruction, sacrococcygeal teratoma, chorio angioma, neural tube defects, twin-twin transfusion syndrome and acardiac t win. The aim is to improve the intrauterine situation by minimally invasive surgery and to prevent irreversible damage. After delivery permanent repai r is possible in cases with fetal malformations. Diaphragmatic hernia is th e best example for the development from maximally invasive open fetal surge ry to minimally invasive endoscopic surgery. There is still a lot of experi mental work to be done, for example for the correction of diaphragmatic her nia and neural tube defects. However, in other areas such as severe second trimester twin-twin transfusion syndrome, endoscopic surgery is a well esta blished technique in certain centres for fetal medicine. Endoscopic laser c oagulation of the Vascular placental anastomoses is a causal therapy and sh ows better results than serial amniodrainages. After 160 laser coagulations performed in our institution, the survival rates are as follows: overall 6 8% of fetuses, with two survivors in 54% and at least one survivor in 83% o f pregnancies.