Chorioamniotic Membrane Separation Following Fetal Surgery

Journal of Perinatology : Official Journal of the California Perinatal Association. Jul-Aug, 2002  |  Pubmed ID: 12082478

As the volume of fetal surgery cases has steadily increased, an increasing incidence of chorioamniotic membrane separation (CMS) has been noted. Due to the potential adverse consequences from this abnormality, we reviewed the last decade of experience with fetal intervention at our institution and examined the incidence and outcomes of fetuses given this diagnosis.

Fetal Therapy for Giant Hepatic Cysts

Journal of Pediatric Surgery. Oct, 2002  |  Pubmed ID: 12378477

Cystic mesenchymal hamartoma is an extremely rare, benign tumor. Rapid growth to a giant size can pose a threat not only in early childhood but also during fetal life. The experience with 2 antenatally diagnosed giant hepatic cysts with widely disparate approaches to management, treatment, and outcome is presented. A giant hepatic cyst was diagnosed on routine screening ultrasound scan. Because of its extremely massive size, the cyst was treated in utero with repeated aspirations, primarily for obstetric considerations. The infant did well, and the lesion was excised laparoscopically during the neonatal period. A second fetus with a giant hepatic cyst was not treated in utero, and the pregnancy continued to term. Nonimmune hydrops fetalis developed, and the fetus was delivered prematurely at 34 weeks. At birth, the infant was noted to have diffuse neurologic injury and no urine output despite normal-appearing kidneys. The lesion was excised during the neonatal period by open laparotomy. Observations at the time of surgery and pathologic studies of the placenta showed aneurysmal dilatation of the placental veins suggesting in utero compression of the fetal intraabdominal umbilical vein. The infant died shortly after birth. The experience with these 2 cases suggests the possibility that giant mesenchymal hamartoma diagnosed in utero may cause umbilical venous obstruction leading to ischemia during fetal life. Decompression of giant hepatic cysts may reverse this phenomenon and allow normal fetal development.

Fetal Surgery for Myelomeningocele: Panacea or Peril?

World Journal of Surgery. Jan, 2003  |  Pubmed ID: 12557043

Myelomeningocele affects thousands of children worldwide with devastating consequences. In an effort to improve neurologic outcome, fetal surgery has been performed for myelomeningocele for the past 5 years. Sensorimotor function is not appreciably improved, although there may be a reduction in hindbrain herniation and a decreased need for ventriculoperitoneal shunting. The long-term clinical consequences of these findings are not clear. What is clear, however, is that further study in the form of a prospective, randomized trial is mandatory.

Fetal Intervention for Complications of Monochorionic Twinning

World Journal of Surgery. Jan, 2003  |  Pubmed ID: 12557045

All multiple gestation pregnancies have a significantly higher risk of fetal morbidity and mortality than singleton pregnancies. The risks become progressively greater as the number of fetuses increases. Among twin pregnancies, there is a greater danger of an adverse outcome when the twins share a single placenta (monochorionic), than if each has a separate placenta (dichorionic). A still greater danger exists when monochorionic twins also share a single amniotic sac. Fetal surgical interventions now exist to treat many of the complications associated with twin gestation pregnancies.

Spectrum of Intrapartum Management Strategies for Giant Fetal Cervical Teratoma

Journal of Pediatric Surgery. Mar, 2003  |  Pubmed ID: 12632365

The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management.

Resolution of Hydrops Fetalis in Congenital Cystic Adenomatoid Malformation After Prenatal Steroid Therapy

Journal of Pediatric Surgery. Mar, 2003  |  Pubmed ID: 12632377

Development of hydrops fetalis in fetuses with congenital cystic adenomatoid malformations (CCAM) is a significant risk factor for fetal or neonatal demise. In rare cases, resolution of CCAM has occurred, presumably owing to lesion maturation or involution. Steroid therapy, utilized for lung maturity, has been postulated to accelerate this process. The natural history of hydropic fetuses with CCAM after receiving steroid therapy is presented.

Comparison of Drainage Techniques for Biliary Atresia

Journal of Pediatric Surgery. Jul, 2003  |  Pubmed ID: 12861527

Traditional Kasai portoenterostomy and porto-appendiceal duodenostomy have been utilized for biliary atresia. Differences in outcome between patients who underwent either Kasai portoenterostomy or porto-appendiceal duodenostomy were compared.

One-stage Transanal Soave Pullthrough for Hirschsprung Disease: a Multicenter Experience with 141 Children

Annals of Surgery. Oct, 2003  |  Pubmed ID: 14530728

The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it.

Fetal Surgery for Sacrococcygeal Teratoma

Clinics in Perinatology. Sep, 2003  |  Pubmed ID: 14533891

A great deal has been learned regarding the natural history and pathophysiology of fetal SCT. The logic behind fetal intervention for SCT and hydrops appears to be correct, and open and minimal access techniques of fetal intervention have been shown to be feasible. The development of fetal intervention for SCT has mirrored those developed for other diseases such as congenital diaphragmatic hernia. In a recent presentation, Harrison, the original pioneer in fetal surgery, outlined trends in fetal intervention. The first trend is that of moving from open, invasive techniques to minimally invasive techniques. In the case of SCT surgeons are moving from open resection to RFA and possibly to fetoscopic resection. The second trend outlined by Harrison is a movement away from total in utero repair of a defect that recapitulates postnatal treatment and toward manipulation of fetal pathophysiology to reverse life-threatening events. In SCT surgeons employ RFA to ablate causative blood vessels to reverse fetal hydrops with the knowledge that these fetuses will require postnatal resection of the tumor. In contrast to resection, RFA requires less time and significantly less maternal morbidity than open resection. Further study is required to determine the role of minimal access techniques in SCT. Future directions for treatment of fetal SCT with hydrops might include fetoscopic resection or high-intensity ultrasound ablation.

The Ex Utero Intrapartum Treatment (EXIT) Procedure

Seminars in Neonatology : SN. Jun, 2003  |  Pubmed ID: 15001139

The ex utero intrapartum treatment (EXIT) procedure was originally developed to reverse temporary tracheal occlusion in patients who had undergone foetal surgery for severe congenital diaphragmatic hernia (CDH). In a select group of foetuses with CDH, tracheal occlusion is used to obstruct the normal flow of foetal lung fluid and to stimulate lung expansion and growth. With the airway obstructed, airway management at birth is critical. The solution was to arrange delivery in such a way that the occlusion could be removed and the airway secured while the baby remained on placental support. If the uterus was kept relaxed and the utero-placental blood flow kept intact, the foetus could remain on a maternal 'heart-lung machine' while the airway was secured. While the technique of tracheal occlusion remains under study in clinical trials, EXIT procedures have been shown to be useful for management of other causes of foetal airway obstruction.

The Ex Utero Intrapartum Treatment Procedure: Looking Back at the EXIT

Journal of Pediatric Surgery. Mar, 2004  |  Pubmed ID: 15017555

The ex utero intrapartum treatment (EXIT) procedure was developed originally for management of airway obstruction after fetal surgery, and indications have continued to expand for a variety of fetal anomalies. The authors review their single-institution experience with EXIT.

Initial Experience with Complex Laparoscopic Biliary Surgery in Children: Biliary Atresia and Choledochal Cyst

Journal of Pediatric Surgery. Jun, 2004  |  Pubmed ID: 15185200

Laparoscopic approaches are possible for many pediatric surgical diseases, including complex biliary disorders. The authors describe their early experience with laparoscopic procedures for biliary atresia and choledochal cysts.

Spontaneous Resolution of Prenatal Megalourethra

Journal of Pediatric Surgery. Sep, 2004  |  Pubmed ID: 15359404

Urethral obstruction in the fetus is rare. Whereas proximal obstruction most often is caused by posterior urethral valves, causes of distal obstruction are less well recognized and can include urethral atresia, urethral webs, and anterior urethral valves. These latter abnormalities can lead to urinary retention, incontinence, enuresis, spontaneous bladder rupture, and megacystis. The authors present 3 fetuses (gestational age range, 18 to 20 weeks) in whom distal urethral obstruction was suspected by prenatal ultrasonography in the absence of a demonstrable lesion. All 3 experienced spontaneous resolution of the presumed obstruction. On follow-up, all are alive and well with no adverse genitourinary tract sequelae. No postpartum intervention was required.

The Influence of Portoenterostomy on Transplantation for Biliary Atresia

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Oct, 2004  |  Pubmed ID: 15376306

After portoenterostomy (PE) for biliary atresia (BA), many patients suffer progressive deterioration of liver function and ultimately require liver transplantation. We retrospectively reviewed a single center's experience with pediatric liver transplantation for BA from 1988 to 2002. Sixty-six patients underwent 69 liver transplants for BA. Forty-two (63%) patients had previously undergone Kasai PE, 11 (17%) biliary appendicoduodenostomy (BAD), and 13 (20%) had no prior biliary drainage (NBD). The BAD procedure offered only short-term biliary drainage--the mean interval between PE and transplant was more than twice that for Kasai patients than for BAD patients (132 versus 49 weeks). The transplants included 11 cadaveric partial, 27 cadaveric whole, and 31 living related transplants. Three patients required retransplant. Prior PE did not increase the incidence of major perioperative complications or unplanned reexploration. After transplant, the 1-, 5-, and 10-year actuarial graft survival rates were 87%, 86%, and 80%, respectively. The 1-, 5-, and 10-year actuarial patient survival rates were 91%, 89%, and 83%. PE remains an important bridge to transplant. In conclusion, transplantation for BA offers excellent long-term graft and patient survival.

Myelomeningocele: Characterization of a Surgically Induced Sheep Model and Its Central Nervous System Similarities and Differences to the Human Disease

American Journal of Obstetrics and Gynecology. Oct, 2005  |  Pubmed ID: 16202740

The purpose of this study was to determine how closely the surgically induced sheep myelomeningocele (MMC) model resembles the central nervous system derangements seen in human disease, and identify which aspects of MMC are the result of the early neuronal developmental defect, and which are secondary to the cerebrospinal fluid (CSF) drainage.

Thoracoscopic Resection of Foregut Duplication Cysts

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. Oct, 2006  |  Pubmed ID: 17004883

Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically.

Images in Clinical Medicine. Azygous Lobe

The New England Journal of Medicine. May, 2007  |  Pubmed ID: 17507707

Fetal Surgery for Myelomeningocele

Clinics in Perinatology. Jun, 2009  |  Pubmed ID: 19559329

Fetal intervention for myelomeningocele (MMC) may improve hydrocephalus and hindbrain herniation associated with the Arnold-Chiari II malformation and may reduce the need for ventriculoperitoneal shunting. As of now, there is little evidence that prenatal repair of MMC improves neurologic function. MMC is the first nonlethal disease under consideration and study for fetal surgery. As a result, potential improvements in outcome must be balanced with maternal safety and well-being, in addition to that of the unborn patient.

Prenatal Intraabdominal Bowel Dilation is Associated with Postnatal Gastrointestinal Complications in Fetuses with Gastroschisis

American Journal of Obstetrics and Gynecology. Apr, 2010  |  Pubmed ID: 20044065

The purpose of this study was to determine whether prenatal intraabdominal bowel dilation (IBD) is associated with increased postnatal complications in fetuses with gastroschisis.

Prenatal Steroids for Microcystic Congenital Cystic Adenomatoid Malformations

Journal of Pediatric Surgery. Jan, 2010  |  Pubmed ID: 20105595

The purpose of this study is to evaluate the effect of prenatal steroid treatment in fetuses with sonographically diagnosed congenital cystic adenomatoid malformations (CCAMs).

Long-term Surgical Outcomes in Congenital Diaphragmatic Hernia: Observations from a Single Institution

Journal of Pediatric Surgery. Jan, 2010  |  Pubmed ID: 20105597

Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors.

Magnetic Mini-mover Procedure for Pectus Excavatum II: Initial Findings of a Food and Drug Administration-sponsored Trial

Journal of Pediatric Surgery. Jan, 2010  |  Pubmed ID: 20105602

The Magnetic Mini-Mover Procedure (3MP) uses a magnetic implant coupled with an external magnet to generate force sufficient to gradually remodel pectus excavatum deformities. This is an interim report of the evolution of the 3MP during a Food and Drug Administration-approved clinical trial.

Perinatal Outcome of Conservative Management Versus Fetal Intervention for Twin Reversed Arterial Perfusion Sequence with a Small Acardiac Twin

Fetal Diagnosis and Therapy. 2010  |  Pubmed ID: 20215730

To examine the outcomes of patients with twin reversed arterial perfusion (TRAP) sequence in which the acardiac twin was

Image of the Month--quiz Case. Gastric Duplication Cyst

Archives of Surgery (Chicago, Ill. : 1960). Oct, 2010  |  Pubmed ID: 20956774

A High-power Versatile Wireless Power Transfer for Biomedical Implants

Conference Proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference. 2010  |  Pubmed ID: 21096712

Implantable biomedical actuators are highly desired in modern medicine. However, how to power up these biomedical implants remains a challenge since most of them need more than several hundreds mW of power. The air-core based radio-frequency transformer (two face-to-face inductive coils) has been the only non-toxic and non-invasive power source for implants for the last three decades [1]. For various technical constraints, the maximum delivered power is limited by this approach. The highest delivered power reported is 275 mW over 1 cm distance [2]. Also, the delivered power is highly vulnerable to the coils' geometrical arrangement and the electrical property of the medium around them. In this paper, a novel rotating-magnets based wireless power transfer that can deliver ∼10 W over 1 cm is demonstrated. The delivered power is significantly higher than the existing start-of-art. Further, the new method is versatile since there is no need to have the impedance matching networks that are highly susceptible to the operating frequency, the coil arrangement and the environment.

The Fetus As a Cardiac Patient: Assessment and Therapy of Cardiovascular Pathology Before Birth

International Journal of Pediatrics. 2010  |  Pubmed ID: 21253501

Bringing the Skills Laboratory Home: an Affordable Webcam-based Personal Trainer for Developing Laparoscopic Skills

Journal of Surgical Education. Mar-Apr, 2011  |  Pubmed ID: 21338965

The purpose of this work was to develop a more flexible system of laparoscopic surgery training with demonstrated effectiveness and construct validity.

Magnamosis II: Magnetic Compression Anastomosis for Minimally Invasive Gastrojejunostomy and Jejunojejunostomy

Journal of the American College of Surgeons. Jan, 2011  |  Pubmed ID: 21184956

Previously we demonstrated the safety and patency of a magnetic compression anastomosis (magnamosis). We present the further development of this technique, with specific focus on optimizing device design for minimally invasive magnamosis.

Microcystic Congenital Pulmonary Airway Malformation with Hydrops Fetalis: Steroids Vs Open Fetal Resection

Journal of Pediatric Surgery. Jan, 2012  |  Pubmed ID: 22244389

Congenital pulmonary airway malformations (CPAM) are rare lesions often diagnosed during routine prenatal ultrasound. The presence of hydrops fetalis is an indicator of poor prognosis. Here we present a retrospective review of fetuses undergoing either open fetal surgery or steroids for predominantly microcystic CPAM with hydrops fetalis.

Magnetic Mini-mover Procedure for Pectus Excavatum III: Safety and Efficacy in a Food and Drug Administration-sponsored Clinical Trial

Journal of Pediatric Surgery. Jan, 2012  |  Pubmed ID: 22244409

The magnetic mini-mover procedure (3MP) uses magnetic force to gradually remodel pectus excavatum deformity. A magnet is implanted on the sternum and coupled with an external magnetic brace. Under Investigational Device Exemption and Institutional Review Board approval, we performed a pilot study of safety, probable efficacy, and cost-effectiveness of this new treatment of an orphan disease using an implantable pediatric device.