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Fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia
With Dr. Beth Romesky · hosted by Dr. Jill Knareth
Chapter 2 of 4
Scope navigation
Anatomic Navigation and Scope Manipulation
Cued at 2:23 · press play
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski
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4 min · Published Jul 2026
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What the experts said
FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.
A standard fetoscope with a side channel is used, and the balloon is worked through the side channel.
The tongue is an easy landmark to identify during FETO because it is bumpy.
Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.
If the baby's head is not perfectly aligned with the scope, twisting and turning is required to navigate through the mouth.
The epiglottis is sought as a landmark to guide navigation toward the trachea.
Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.
The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.
The balloon should not be driven into one side of the trachea; it must be inflated in the main trachea.
The scope is backed up during balloon inflation to allow visualization of the balloon as it inflates.
The goal of FETO is to trap fluid in the lungs to allow the lungs to expand and grow.
FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
After deployment, the scope is advanced one more time to confirm the balloon is below the vocal cords.