The combined method: a novel access technique for fetal endoscopic surgery

Lessons from the Barn to the Operating Suite: A Comprehensive Review of Animal Models for Fetal Surgery

The International Fetal Medicine and Surgery Society was created in 1982 and proposed guidelines for fetal interventions that required demonstrations of the safety and feasibility of intended interventions in animal models prior to application in humans. Because of their short gestation and low cost, small animal models are useful in early investigation of fetal strategies. However, owing to the anatomic and physiologic differences between small animals and humans, repeated studies in large animal models are usually needed to facilitate translation to humans. Ovine (sheep) models have been used the most extensively to study the pathophysiology of congenital abnormalities and to develop techniques for fetal interventions. However, nonhuman primates have uterine and placental structures that most closely resemble those of humans. Thus, the nonhuman primate is the ideal model to develop surgical and anesthetic techniques that minimize obstetrical complications.

Tératomes sacrococcygiens. Y a-t-il une place pour le traitement in utero des formes compliquées ? À propos de trois cas

The majority of sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops and fetal death and a preeclampsia-like syndrome in the mother. This is due to high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. In these cases, in utero treatment may offer improved chances of survival, and emerging technologies should lower fetal and maternal morbidity. Nevertheless, these therapeutics need to be correctly evaluated.