Robert Bergholz1,2, Thomas Krebs3, Birte Cremieux4, Carla Georgi4, Felipe Fromm4, Michael Boettcher4, Thomas Andreas3, Bastian Tiemann5, Katharina Wenke4, Konrad Reinshagen4, Kurt Hecher6. 1. Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, University Hospital of Schleswig-Holstein, UKSH Kiel Campus, Arnold-Heller-Strasse 3, 20415, Kiel, Germany. robert.bergholz@uksh.de. 2. Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. robert.bergholz@uksh.de. 3. Department of Pediatric Surgery, Ostschweizer Children's Hospital, Claudiusstrasse 6, 9006, St. Gallen, Switzerland. 4. Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. 5. Department of Experimental Animal Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. 6. Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Abstract
INTRODUCTION: This is the cumulative technical report on the operative procedures and limitations of fetoscopic bag insertion, intestinal bag placement, and bag fixation to the fetus in a series of pilot studies in an ovine model for prenatal treatment of gastroschisis. MATERIAL AND METHODS: In 24 German blackhead sheep, a surgically created gastroschisis was managed by fetoscopic placement of the extruded intestines into a bag. The bag was then fastened onto the fetal abdominal wall. Different materials (sterile gloves, latex condoms, laparosopic retrieval bags) and different fixation techniques (laparoscopic staplers, interrupted and continuous sutures) have been examined. The fetuses were retrieved and evaluated at the end of gestation. RESULTS: Uterine bag insertion was successful in 15 of 24 (62.5%) and intestinal bag placement in 10 of 15 available fetuses (66.6%). The main factor limiting fetoscopic procedures was chorioamniotic separation (CAS). Sterilized condoms provided the most appropriate type of bags and the V-Loc™ running suture, the most expedient type of fixation, which was achieved in 9 of the 10 fetuses (complete = 2, partially = 7) by using a three port access (5 mm and 2 × 3 mm). All bags were encountered completely or partially dislocated from the fetus at the end of gestation. CONCLUSIONS: Fetoscopic intestinal bag placement and fixation in gastroschisis technically demanding. None of the evaluated techniques led to permanent anchorage of the bag to the fetus. The development of specially designed instruments, bags and fixation methods is required to optimize this approach.
INTRODUCTION: This is the cumulative technical report on the operative procedures and limitations of fetoscopic bag insertion, intestinal bag placement, and bag fixation to the fetus in a series of pilot studies in an ovine model for prenatal treatment of gastroschisis. MATERIAL AND METHODS: In 24 German blackheadsheep, a surgically created gastroschisis was managed by fetoscopic placement of the extruded intestines into a bag. The bag was then fastened onto the fetal abdominal wall. Different materials (sterile gloves, latex condoms, laparosopic retrieval bags) and different fixation techniques (laparoscopic staplers, interrupted and continuous sutures) have been examined. The fetuses were retrieved and evaluated at the end of gestation. RESULTS: Uterine bag insertion was successful in 15 of 24 (62.5%) and intestinal bag placement in 10 of 15 available fetuses (66.6%). The main factor limiting fetoscopic procedures was chorioamniotic separation (CAS). Sterilized condoms provided the most appropriate type of bags and the V-Loc™ running suture, the most expedient type of fixation, which was achieved in 9 of the 10 fetuses (complete = 2, partially = 7) by using a three port access (5 mm and 2 × 3 mm). All bags were encountered completely or partially dislocated from the fetus at the end of gestation. CONCLUSIONS: Fetoscopic intestinal bag placement and fixation in gastroschisis technically demanding. None of the evaluated techniques led to permanent anchorage of the bag to the fetus. The development of specially designed instruments, bags and fixation methods is required to optimize this approach.
Authors: Luc A J Roelofs; Paul J Geutjes; Christina A Hulsbergen-van de Kaa; Alex J Eggink; Toin H van Kuppevelt; Willeke F Daamen; A Jane Crevels; Paul P van den Berg; Wout F J Feitz; René M H Wijnen Journal: J Pediatr Surg Date: 2013-03 Impact factor: 2.545
Authors: Jacob T Stephenson; Kullada O Pichakron; Lan Vu; Tim Jancelewicz; Ramin Jamshidi; J Kevin Grayson; Kerilyn K Nobuhara Journal: J Pediatr Surg Date: 2010-01 Impact factor: 2.545
Authors: Andreas Meinzer; Ibrahim Alkatout; Thomas Franz Krebs; Jonas Baastrup; Katja Reischig; Roberts Meiksans; Robert Bergholz Journal: J Clin Med Date: 2020-12-10 Impact factor: 4.241