PERCUTANEOUS FETAL ACCESS AND UTERINE CLOSURE FOR FETOSCOPIC SURGERY - LESSONS LEARNED FROM 16 CONSECUTIVE PROCEDURES IN PREGNANT SHEEP

Background: Maternal morbidity and preterm labor from fetal surgery mi ght be minimized by a percutaneous technique for fetal access and uter ine closure. Methods: In each of 16 ewes, we inserted three trocars pe rcutaneously into the amniotic cavity using ultrasound and fetoscopic guidance. In six ewes, percutaneous uterine closure after the procedur e was attempted, We assessed feasibility and acute complications of ou r technique during surgery and at autopsy. Results: We achieved percut aneous fetal access in 14 ewes and closed the uterus percutaneously in all six ewes attempted. Fetal injury was related to amnioinfusion or fixation of chorioamniotic membranes. Other complications were trocar dislodgment and damage to uterine wall and chorioamniotic membranes. T he latter complication was prevented using balloon-tipped trocars. Con clusions: Percutaneous intraamniotic access and uterine closure for fe toscopic surgery can be achieved reliably with little maternal and fet al morbidity in sheep. Minor modifications are desired to apply this a pproach in humans.