Intrauterine endoscopic creation of urinary tract obstruction in the fetal lamb: A model for fetal surgery

OBJECTIVE: Our purpose was to evaluate the feasibility of intrauterine endoscopic fetal surgery in a fetal lamb model by creating a urinary tract obstruction. STUDY DESIGN: Lower urinary tract obstruction was created by ligation of the urethra and urachus in 21 fetal lambs, eight at 95 to 105 days&#...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 1995-05, Vol.172 (5), p.1422-1426
Main Authors: Deprest, Jan A., Luks, François I., Peers, Koen H.E., Vandenberghe, Kamiel, Lerut, Toni E., Brosens, Ivo A., Van Assche, F.André
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Diseases of mother, fetus and pregnancy
endoscopy
Feasibility Studies
Female
fetal lamb
Fetal Monitoring - veterinary
Fetal surgery
Fetoscopy
Fetus - surgery
Gynecology. Andrology. Obstetrics
Ligation
Male
Medical sciences
Models, Biological
Pregnancy
Pregnancy. Fetus. Placenta
Sheep
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Urachus - surgery
Urethra - surgery
Urethral Obstruction
urinary tract obstruction
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Summary:OBJECTIVE: Our purpose was to evaluate the feasibility of intrauterine endoscopic fetal surgery in a fetal lamb model by creating a urinary tract obstruction. STUDY DESIGN: Lower urinary tract obstruction was created by ligation of the urethra and urachus in 21 fetal lambs, eight at 95 to 105 days' gestation (term 145 days) and 13 at 70 to 75 days. The endoscopic approach consisted of a 0-degree 5 mm telescope, three 5 mm cannulas, uterine distention by amnioinfusion, and adapted instrumentation. Intrauterine fetal monitoring included temperature and pulse oximetry registration. RESULTS: In 20 cases the urachus could be identified and ligated inside the umbilical cord. The urethra was ligated in the anterior abdominal wall ( n = 7) obstructed at the level of the penis ( n = 13). Mean fetal heart rate was 147 ± 35 beats/min, and fetal temperature at the end of intervention was 38.14° ± 2.1° C. The overall postoperative survival rate was 76%. CONCLUSION: Urinary tract obstruction can be created endoscopically in the fetal lamb. This operation can serve as a model for endoscopic fetal surgery.
ISSN:0002-9378
1097-6868
DOI:10.1016/0002-9378(95)90472-7