Gasless Fetoscopy: A New Approach to Endoscopic Closure of a Lumbar Skin Defect in Fetal Sheep

• Processo: 08/03957-6
• Modalidade de apoio: Auxílio à Pesquisa - Publicações científicas - Artigo
• Data de Início da vigência: 01 de junho de 2008
• Data de Término da vigência: 30 de novembro de 2008
• Área do conhecimento: Ciências da Saúde - Medicina - Saúde Materno-infantil
• Pesquisador responsável: Denise Araujo Lapa Pedreira
• Beneficiário: Denise Araujo Lapa Pedreira
• Instituição Sede: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brasil
• Assunto(s): Perinatologia
• Palavra(s)-Chave do Pesquisador: Cirurgia Fetal | Medicina Fetal

Resumo

Objective: To develop a new endoscopic approach for the correction of a myelomeningocele-like defect in fetal sheep.Methods: The fetuses of nine pregnant ewes, with an average gestational age of 115 days were subjected to a 3,0 x 1,5 cm removal of the skin over the lumbar spine, performed through hysterotomy. The uterus was closed, and three 5 mm endoscopic cannulas, without valve mechanisms, were inserted. In the pilot phase (2 animals), we initially worked exclusively in the amniotic fluid space. In the study phase, we partially withdrew the amniotic fluid to completely expose the fetal back. By simply allowing air to enter the amniotic cavity (without gas injection), a working space was created using a uterine lift device. The skin around the defect was dissected and a biosynthetic cellulose material was applied to cover the area. A continuous suture of the skin was performed to completely hide the material.Results: The combined air/fluid space allowed the skin to be successfully closed in 6 out of 7 cases in the study phase. All fetuses were alive at the end of the procedures. Time to complete the endoscopic part of the procedure fell from 3 to 1 hour by the end of this series. Premature birth occurred in 2 of the 4 cases allowed to continue with the pregnancy.Conclusion: A new gasless fetoscopic surgery technique was developed as an alternative to current techniques used for fetal endoscopic surgery. (AU)