[Fetoscopic spina bifida repair animation]
This animation shows a spina bifida repair, done prenatally, using a fetoscopic technique.
In this fetus with spina bifida, you can see an opening in the back, with an exposed spinal
cord. Prenatal repair is most commonly done between 22 and 26 weeks gestation.
Once the mother is under anesthesia, we make an incision in the abdomen to expose the womb.
We may use either a transverse incision, shown here . . . or a midline incision,
as shown here. This animation shows a transverse incision.
After we make the incision and cut through the layer of muscle,
the womb is exposed. Ultrasound helps us to confirm the position
of the fetus and shows us the best location to place the first port for the surgery.
We then expand the amniotic cavity using humidified and heated carbon dioxide,
which creates more space for us to do the repair.
To enable us to see inside the womb,
we insert a camera into the amniotic cavity through the first port. Two additional ports
are then placed under direct vision to allow placement of instruments for the repair.
We inject a cocktail of pain medication,
paralytics and medication to protect the baby’s heartbeat into the gluteal muscle.
We then place a stabilization stitch in the baby’s upper back, above the spina bifida.
We first open up the sac all the way around the spina bifida defect.
Once the sac is completely open, we free the placode, or exposed portion of the spinal cord,
from the surrounding tissue. This procedure, which is called untethering,
allows the placode to fall back down nicely into the spinal canal.
We then raise the skin flap around the defect to loosen up the skin.
This will eventually help us form a water tight closure
of the spinal defect. To protect the placode, we place a patch into the defect.
We anchor the patch on one end to the baby’s back using dissolvable sutures. A second patch
is then placed to give additional protection, and again, it is secured with dissolvable sutures.
We then close the skin over the spinal defect
using dissolvable sutures, when the baby has enough skin to do so. If the defect is too
large and we are not able to close the skin, we use a skin patch, forming a water tight closure.
The stabilization stitch is removed. The repair is now complete.
The ports are removed and the port sites are closed with dissolvable sutures.
The amniotic fluid we removed is now replaced
with warm fluid, and antibiotics are placed into the amniotic cavity.
Finally, we close the mother’s abdominal wall muscle, and then close the skin.
Ideally, the pregnancy continues until term,
at which point the baby is delivered vaginally if there is no contraindication.