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Perrone EE, Galganski LA, Tarantal AF, Olstad KJ, Treadwell MC, Berman DR, Jarboe MD, Mychaliska GB, Farmer DL. Fetal Surgery in the Primate 4.0: A New Technique 30 Years Later. Fetal Diagn Ther 2020; 48:43-49. [PMID: 33108788 DOI: 10.1159/000511355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Open fetal surgery requires a hemostatic hysterotomy that minimizes membrane separation. For over 30 years, the standard of care for hysterotomy in the gravid uterus has been the AutoSuture Premium Poly CS*-57 stapler. OBJECTIVE In this study, we sought to test the feasibility of hysterotomy in a rhesus monkey model with the Harmonic ACE®+7 Shears. METHODS A gravid rhesus monkey underwent midgestation hysterotomy at approximately 90 days of gestation (2nd trimester; term = 165 ± 10 days) using the Harmonic ACE®+7 Shears. A two-layer uterine closure was completed and the dam was monitored by ultrasound intermittently throughout the pregnancy. At 58 days after hysterotomy (near term), a final surgery was performed to evaluate the uterus and hysterotomy site. RESULTS A 3.5-cm hysterotomy was completed in 2 min 7 s. The opening was hemostatic and the membranes were sealed. Immediately after closure and throughout the pregnancy, ultrasound revealed intact membranes without separation and normal amniotic fluid levels. At term, the scar was well healed without signs of thinning or dehiscence. CONCLUSIONS The Harmonic ACE®+7 Shears produced a hemostatic midgestation hysterotomy with membrane sealing in the rhesus monkey model. Importantly, healing was acceptable.
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Affiliation(s)
- Erin E Perrone
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA, .,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA,
| | - Laura A Galganski
- Department of Surgery, UC Davis Children's Hospital, University of California, Davis, Sacramento, California, USA
| | - Alice F Tarantal
- Departments of Pediatrics and Cell Biology and Human Anatomy, School of Medicine, and California National Primate Research Center, University of California, Davis, California, USA
| | - Katie J Olstad
- Laboratory Animal Pathology, California National Primate Research Center, University of California, Davis, California, USA
| | - Marjorie C Treadwell
- Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah R Berman
- Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - George B Mychaliska
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana L Farmer
- Department of Surgery, UC Davis Children's Hospital, University of California, Davis, Sacramento, California, USA.,Fetal Care and Treatment Center, University of California, Davis, Davis, California, USA
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