AMNIOSCOPIC ENDOFETAL ILLUMINATION WITH INFRARED-GUIDED FIBER

Minimally invasive amnioscopic surgery has several potential advantage s over traditional open hysterotomy, including the reduction of the ri sk of preterm labor and spontaneous abortion, Adequate visibility of t he fetal target organ is obligate to the success of in utero procedure s, This is a preliminary report on the use of an end-emitting infrared fiber (750 mu m; 810-nm wavelength) that allows image fusion with Inf ravision(TM) videocamera systems (Gabriel Medical, Lafayette, LA), Onc e placed, this fiber can serve as a homing beacon to identify the feta l bladder in the surgical creation of an amnioscopic vesicostomy for t he relief of obstructive uropathies. Under general endotracheal haloth ane anesthesia, amnioscopic access was established in time-dated pregn ant ewes using one 3.7-mm and two radially dilating 2-mm to 5-mm troca rs. This access allowed the investigation of several methods of intrav esicular infrared fiber placement, Ultrasound-guided direct needle pun cture is the quickest method of accessing the fetal bladder but is unr eliable when the bladder is empty, Accurate placement of the access ne edle directly over the suprapubic region was accomplished with amniosc opic assistance, The fiber was also placed transurethrally in one fema le and one male fetus, with subsequent perforation of the female's bla dder. Successful infrared bladder illumination was accomplished in all animals, The fusion integration of this camera system allows simultan eous viewing by visible spectrum and near-infrared wavelengths. We bel ieve that this system provides a further degree of safety for amniosco pic procedures.