Lucie Guilbaud1,2, Nathalie Roux3, Stéphanie Friszer3,4, Charles Garabedian3, Ferdinand Dhombres3,4, Bettina Bessières5, Catherine Fallet-Bianco6, Federico Di Rocco7, Michel Zerah8,9, Jean-Marie Jouannic3,4. 1. Service de Médecine Foetale, Hôpital Armand Trousseau, APHP, 26 avenue du Docteur Arnold Netter, 75012, Paris, France. lucie.guilbaud@gmail.com. 2. Université Pierre et Marie Curie, Paris 6, Paris, France. lucie.guilbaud@gmail.com. 3. Service de Médecine Foetale, Hôpital Armand Trousseau, APHP, 26 avenue du Docteur Arnold Netter, 75012, Paris, France. 4. Université Pierre et Marie Curie, Paris 6, Paris, France. 5. Service d'Histologie-Embryologie et Cytologie, Hôpital Necker-Enfants Malades, APHP, Paris, France. 6. Laboratoire de Neuropathologie, Hôpital Sainte Justine, Montréal, Québec, Canada. 7. Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, CHU de Lyon, Lyon, France. 8. Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Paris, France. 9. Université René Descartes, Paris 5, Paris, France.
Abstract
PURPOSE: This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model. METHODS: Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed. RESULTS: Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3. CONCLUSION: Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.
PURPOSE: This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model. METHODS: Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed. RESULTS: Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3. CONCLUSION: Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.
Entities:
Keywords:
Fetal surgery; Fetal therapy; Fetoscopy; Open spina bifida; Sheep
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