Hey there, listeners. This is Rod Gerardo, research resident at Cincinnati Children's Hospital Medical Center. Whether you're watching us on YouTube, listening to us on Apple Podcasts, Stitcher, Spotify, SoundCloud, the best way to listen is on the Stay Current Pediatric Surgery app. It's brought to you by Cincinnati Children's Hospital Medical Center, Children's Mercy at Kansas City, and the Journal of Pediatric Surgery. It's in the Apple App Store, it's in the Google Play Store. Download it today, but until then, Enjoy the episode. Neural tube defects are the most common congenital central nervous system anomaly. So today, to continue our series on fetal surgery, We're gonna hear from Doctor Fung Lim. He's the director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center. Today's video, we're gonna watch how they treat myelomeningocele or spina bifida, intrauterine. That's right. Surgery on a fetus. So, without further ado, here's Doctor Lim. In this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord. So just to review, myelomeningocele or spina bifida is the most common neural tube defect. The patient is born with a cleft in the vertebral column, and then there's a defect in the skin, so the meninges and the spinal cord are actually exposed. The patient may be left with neural defects based on the level of the spinal cord, where the lesion is. And at what gestational age do we normally do this surgery? Prenatal repair is most commonly done between 22 and 26 weeks gestation. When it comes to the approach, you actually have two options for the incision. Once the mother is under anesthesia, we make an incision in the abdomen to expose the wound. We may use either a transverse incision shown here or a midline incision. As shown here. This animation shows a transverse incision. After we make the incision and cut through the layer of muscle, the wound is exposed. Under ultrasound guidance, they then place the first port. And once that's placed, we then expand the amniotic cavity using humidified and heated carbon dioxide, which creates more space for us to do the repair. To enable us to see inside the womb, we insert a camera into the amniotic cavity through the first port. Two additional ports are then placed under direct vision to allow placement of instruments for the repair. Anesthesia is then induced on the baby via an intragluteal injection. We then place a stabilization stitch in the baby's upper back above the spina bifida. The first step is to open the sack, then they dissect around the sack circumferentially as shown here. Once the sack is completely open. We freed the placo. By placode, he means that open area of exposed neural tissue. This procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal. OK, next they have to create a skin flap to loosen up the skin. This will eventually help us form a watertight closure of the spinal defect. I know what you're thinking, how are you gonna cover this placode? To protect the placcode, we place a patch into the defect. We anchor the patch on one end to the baby's back using dissolvable sutures. A second patch is then placed to give additional protection. And again, it is secure with dissolvable sutures. We then close the skin over the spinal defect using dissolvable sutures when the baby has enough skin to do so. But what if the defect is too big and you can't pull those two ends of skin together? We use a skin patch, forming a watertight closure. The stabilization stitch is removed. The repair is now complete. Then all the ports are going to come out. Port sites are closed with dissolvable sutures. The amniotic fluid we've removed is now replaced with warm fluid and antibiotics are placed into the amniotic cavity. And then the last step, the closure, both of the abdominal wall and the skin. The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term. So there you have it, another complex fetoscopic procedure brought to you by the Fetal Care Center at Cincinnati Children's Hospital Medical Center. Thank you, Doctor. limb. Did you love this episode? Did you hate it? Either way, leave a comment below whether you're watching us on YouTube, listening to us on Apple Podcast, Stitcher, Spotify, SoundCloud, or on the state current pediatric surgery app. It's in the Apple App Store, it's in the Google Play Store. Download it today, but until then, remember, knowledge should be free.
Comments