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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski

Video Published 2026-07-13

Timestops (3)

FETO Procedure Overview and Lung Expansion

Scope Navigation and Anatomical Landmarks

Balloon Placement and Detachment Technique

Topic Overview

A procedural demonstration of fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia, showing the percutaneous placement of a balloon in the fetal trachea to trap lung fluid and promote lung growth. The procedure uses a single trocar through the maternal abdominal wall, navigates fetal anatomy using landmarks (tongue, epiglottis, vocal cords, carina), and deploys a water-filled balloon below the vocal cords. Key technical considerations include avoiding membrane damage from excessive scope torquing and confirming tracheal (not esophageal) placement by visualizing the carina.

Key Takeaways

FETO uses a single percutaneous trocar to place a water-filled balloon in the fetal trachea, trapping lung fluid to promote growth. (0:33)
Always advance the scope to visualize the carina—this confirms tracheal (not esophageal) placement and guides balloon positioning. (2:36)
Minimize scope torquing through membranes to prevent damage; use intermittent fluid irrigation to push tissue away during navigation. (1:29)
Balloon inflation (0.65-0.8 mL) should occur in the main trachea below the vocal cords, not driven into one side of the airway. (2:56)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Speaker 1 — host
Jill Knarath — host
Dr. Beth Rymeski — guest

Chapters

0:01Introduction and Procedure Overview — Introduction to FETO procedure and its mechanism: percutaneous trocar placement through maternal abdominal wall, fetoscope with side channel for balloon delivery, goal of trapping lung fluid to prevent pulmonary hypoplasia in CDH.
1:03Anatomical Navigation — Step-by-step navigation through fetal anatomy: identifying nose, mouth, tongue as landmark, advancing scope with intermittent fluid, locating epiglottis, avoiding esophagus, advancing through vocal cords to carina while minimizing membrane torque.
2:36Balloon Positioning and Deployment — Advancing scope to carina for confirmation, backing up to position balloon in main trachea, inflating with 0.65-0.8 mL water while watching deployment, detaching and confirming final position below vocal cords.
3:48Summary and Conclusion — Final confirmation imaging and procedural summary emphasizing careful scope manipulation for successful placement.

Key claims

0:33FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus — Dr. Beth Rymeski
0:42The procedure uses a standard fetoscope with a side channel through which the balloon is worked — Dr. Beth Rymeski
0:47The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow — Jill Knarath
0:53FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies — Jill Knarath
1:21The tongue is an easy landmark during FETO because it is bumpy — Dr. Beth Rymeski
1:29Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away and allow easier advancement — Dr. Beth Rymeski
1:38If the baby's head is not perfectly aligned with the scope, twisting and turning is required to navigate through the mouth — Dr. Beth Rymeski
1:58The epiglottis is sought as a landmark to guide navigation — Dr. Beth Rymeski
2:23Excessive torquing of the membranes should be avoided because the scope goes through the abdominal and uterine walls and could cause membrane damage — Dr. Beth Rymeski
2:36The scope should always be advanced until the carina is visualized to confirm tracheal position and determine location within the trachea — Dr. Beth Rymeski
2:56The balloon should not be driven into one side of the trachea but should inflate in the main trachea — Dr. Beth Rymeski
3:03The scope is backed up as the balloon is inflated to allow visualization of balloon inflation — Dr. Beth Rymeski
3:08The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea — Jill Knarath
3:29The balloon contains a small metal ball that can be visualized — Dr. Beth Rymeski
3:48Final confirmation requires visualizing that the balloon is below the vocal cords and in the main trachea — Dr. Beth Rymeski

Cases discussed

1:03Live FETO procedure demonstration on a fetus with CDH

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Keywords

congenital diaphragmatic hernia pulmonary hypoplasia FETO fetoscopic endoluminal tracheal occlusion percutaneous intervention Cincinnati Children's Hospital Stay Current MD GlobalCast MD

Hashtags

#FetalSurgery #CDH #FETO #PrenatalIntervention #PediatricSurgery

Transcript

Globalcast MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. I'm Jill Knarath with Stay Current MD. In this video, Dr. Beth Romesky of Cincinnati Children's goes over the procedural steps of Fido. This procedure uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it. This traps fluid in the lungs, allowing the lungs to expand and grow. So this is just a little schematic of what this looks like. For it's a percutaneous intervention on mom. So it's one trocar that we place through mom's abdominal wall into the uterus and then use a standard feetoscope that has a side channel and we can work the balloon through the side channel. The goal of Fido is to fluid to stay in the lungs and allow the lungs to expand and grow. This helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies. Now, let's get an inside look into real life feto. We're looking at the tip of the baby's nose there. And we're going to go, so there's the nose. We're going to go into the mouth. Doctor Rumeski says the next step is to find the tongue as a landmark. So let's see how that's done. As there's the upper lip there, you're gonna see the lower lip. And then the tongue is an easy thing to see because it's all bumpy, right? So the tongue is a very easy landmark when you're doing a feto. Next, they need to advance the scope. We also have fluid hooked up to the scope as we're doing this, so we can intermittently turn on and off the fluid to push tissue away from the scope to allow us to advance it easier. If the baby's head is not perfectly in alignment with the scope, you have to do some twisting and turning. You can kind of see we're trying to navigate through the mouth. In this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right? So you back up the scope. Let's see how they navigate once they're in the mouth. We're really looking to find the epiglottis here to give us an idea of where we're going, and you just got a hint of it there in the corner of the scope. So here we're trying to get this to advance through the cords there, doing some manipulation with the scope. It seems like manipulating the scope is a key part of this procedure, but Doctor Romesky does caution against aggressive use of this maneuver. You also don't want to be torquing the membranes too much, right? Because remember this is going through. The abdominal wall through the uterine wall, and we don't want it to cause any membrane damage from excessive turning of the scope. Next, they advance into the trachea. You always advance the scope till you see the carina, right? That tells you both where you are in the trachea. And confirms that you're in the trachea and didn't accidentally go in the esophagus. Now they use the introduction catheter and position the balloon. Dr. Romeski walks us through some strategies in balloon positioning, and we're kind of backing up the scope and trying to gauge the distance. We do not want to drive the balloon into one side of the trachea or the other. to inflate in the main trachea. So we're going to back up the scope as we inflate the balloon so that we can watch the balloon inflate. Next, the balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea. Now let's see the balloon deployment. So now we're going to detach it from the advancement and we're going to pull the scope back. So now you can see that the balloon sitting. Nicely in the trachea. There's the top that had been connected. There's that little metal ball that's in it that, um, we'll see later. As they begin to pull out, they noticed that the trochar has advanced into the mouth. Sometimes that happens, so we're going to back all of that out. Now they. A look at the vocal cords and advance the scope one more time just to confirm that the balloons are below the cords. Let's take a look at final positioning. Here's some of the pictures showing the inflated, uh, that it is below the vocal cords and that we can see it. That way we know it's definitely. In the main trachea, to summarize, fetoscopic endoluminal tracheal occlusion is a percutaneous technique done on the mother that allows a fetoscope to enter the fetal trachea. It positions a balloon to occlude the trachea and allow fluid buildup and subsequently lung expansion. It can sometimes be difficult to navigate the anatomy, but with careful scope manipulation, you can achieve a successful placement. Globalcast MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.

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