Fetal Surgery 1981 – Operating on a Baby in the Womb

Dr Pamela Camosy writes: 

"Treating the unborn patient in this emerging field is an exciting endeavour. The previously hidden world of the fetus has begun to be examined more closely, and both the scientific and human dimensions of medicine have expanded forever." 

Fetal surgery refers to operations performed before birth, while the fetus is still in the womb.Fetal surgery, usually performed when the fetus's life is in danger, can be carried out in several different ways:

• In open fetal surgery,  the surgeon cuts through the mother's abdominal and uterine walls to operate on the fetus, which is still connected to the mother through the umbilical cord and placenta. The fetus is returned to the uterus, and the uterine and abdominal walls are closed. When the baby is eventually born, a second operation  (caesarean section)  is performed. One challenge of this surgery is preventing the mother from going into premature labour as a result of damage to her uterus. 
• Minimally invasive fetoscopic surgery  uses real-time video and a tube-like fetoscope (see the "Endoscope" entry) to guide small surgical instruments to the operating site. It is also called  Fetendo  because performing it has been likened to playing a Nintendo video game.

In 1981, paediatric surgeon Michael Harrison at the University of California, San Francisco, performed  the first human open fetal surgery  to save a fetus whose bladder was dangerously enlarged because of a urinary tract obstruction. Dr Harrison inserted a catheter to allow urine to drain, and the baby survived.

Ultrasound can reveal various malformations in the fetus. Fetal surgery  can:

• Open fetal heart valves,
• Repair diaphragmatic hernias,
• Remove life-threatening tumours attached to the fetus's tailbone,
• Repair incomplete closure of the embryonic neural tube associated with the birth defect spina bifida

Selective  laser photocoagulation  is used to close blood vessels that may allow certain abnormal and dangerous blood flows between twin fetuses.

Description of the article image: Minimally invasive fetal surgery can be used to treat twin-to-twin transfusion syndrome (TTTS), in which one twin receives a disproportionate blood supply.

Historical figures mentioned in the article: Michael R. Harrison (b. 1943)

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