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Fetal surgery: principles, indications, and evidence.
[congenital diaphragmatic hernia]
Since
the
first
human
fetal
surgery
was
reported
in
1965
,
several
different
fetal
surgical
procedures
have
been
developed
and
perfected
,
resulting
in
significantly
improved
outcomes
for
many
fetuses
.
The
currently
accepted
list
of
fetal
conditions
for
which
antenatal
surgery
is
considered
include
lower
urinary
tract
obstruction
,
twin-twin
transfusion
syndrome
,
myelomeningocele
,
congenital
diaphragmatic
hernia
,
neck
masses
occluding
the
trachea
,
and
tumors
such
as
congenital
cystic
adenomatoid
malformation
or
sacrococcygeal
teratoma
when
associated
with
developing
fetal
hydrops
.
Until
recently
,
it
has
been
difficult
to
determine
the
true
benefits
of
several
fetal
surgeries
because
outcomes
were
reported
as
uncontrolled
case
series
.
However
,
several
prospective
randomized
trials
have
been
attempted
and
others
are
ongoing
,
supporting
a
more
evidence-based
approach
to
antenatal
intervention
.
Problems
that
have
yet
to
be
completely
overcome
include
the
inability
to
identify
ideal
fetal
candidates
for
antenatal
intervention
,
to
determine
the
optimal
timing
of
intervention
,
and
to
prevent
preterm
birth
after
fetal
surgery
.
Confronting
a
fetal
abnormality
raises
unique
and
complex
issues
for
the
family
.
For
this
reason
,
in
addition
to
a
maternal
-
fetal
medicine
specialist
experienced
in
prenatal
diagnosis
,
a
pediatric
surgeon
,
an
experienced
operating
room
team
including
a
knowledgeable
anesthesiologist
,
and
a
neonatologist
,
the
family
considering
fetal
surgery
should
have
access
to
psychosocial
support
and
a
bioethicist
.
Diseases
Validation
Diseases presenting
"several fetal surgeries"
symptom
congenital diaphragmatic hernia
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