What is fetal surgery?

Fetal surgery refers to surgical procedures performed on a fetus while still in the womb. It is a highly specialized and delicate field of medicine that aims to treat certain life-threatening or debilitating conditions that affect the developing fetus. Fetal surgery is typically carried out during the second or third trimester of pregnancy, when the fetus is sufficiently developed to undergo surgical intervention.

Here are some key points about fetal surgery:

1. Purpose: The primary goal of fetal surgery is to correct or alleviate conditions that could lead to severe health problems, developmental issues, or even death if left untreated. These conditions may include congenital anomalies, structural defects, or functional disorders that develop in utero.

2. Timing: Fetal surgeries are usually performed between 18 and 26 weeks of gestation. This timeframe allows for sufficient fetal development while minimizing the risks associated with premature birth. The specific timing depends on the nature of the condition and the gestational age at which it is detected.

3. Techniques: Fetal surgeries can involve a variety of techniques, such as open fetal surgery, minimally invasive fetal surgery (MIFS), and fetoscopic surgery. Open fetal surgery involves making a small incision in the mother's abdomen and uterus to access the fetus directly. MIFS utilizes smaller incisions and instruments to perform the surgery, resulting in less invasive procedures. Fetoscopic surgery involves inserting a camera and instruments through a small incision to operate on the fetus without the need for open surgery.

4. Conditions Treated: Fetal surgeries can address a wide range of fetal conditions, including:

- Spina bifida: This is a neural tube defect in which the spinal cord and vertebrae fail to develop properly, leading to various degrees of paralysis and other complications. Fetal surgery can help correct the defect by closing the opening in the spine.

- Congenital diaphragmatic hernia (CDH): This is a condition where an opening in the diaphragm allows the abdominal organs to move into the chest cavity, which can impair lung development and cause breathing difficulties. Fetal surgery can involve closing the diaphragmatic defect and allowing the lungs to develop normally.

- Twin-to-twin transfusion syndrome (TTTS): This condition occurs in monochorionic (single-placenta) twins, where unequal blood flow between the fetuses leads to health complications. Fetal surgery may involve laser surgery to separate the blood vessels and balance the blood flow.

5. Risks: As with any surgical procedure, fetal surgeries carry certain risks. These may include risks to the mother, such as infection, preterm labor, or placental abruption. Risks to the fetus can include premature birth, surgical complications, and long-term health effects depending on the specific condition being treated.

6. Long-term Outcomes: The success and outcomes of fetal surgeries depend on various factors, including the nature of the condition, the gestational age at which the surgery is performed, and the expertise of the surgical team. In many cases, fetal surgery can significantly improve the prognosis and overall quality of life for the affected fetus and child.

It is essential to note that fetal surgery is a complex and specialized field of medicine, and decisions regarding whether to proceed with such interventions should be made in consultation with experienced medical professionals, taking into consideration the risks, benefits, and alternatives for the mother and the fetus.