Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
With Dr. Dr. Beth Rymeski · hosted by Dr. Jill Knarath
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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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
The procedure uses a standard fetoscope with a side channel through which the balloon is worked
The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow
FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies
The tongue is an easy landmark when doing 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 in alignment with the scope, twisting and turning is required to navigate through the mouth
The epiglottis is a key landmark to identify when navigating to find the correct location
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 tracheal (not esophageal) placement and indicates position within the trachea
The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea
The scope is backed up as the balloon is inflated so that balloon inflation can be watched
The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea
The balloon contains a little metal ball that can be visualized
Sometimes the trocar advances into the mouth during the procedure and needs to be backed out
Final confirmation requires advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea