In Russia, an operation was performed on a child in the womb without cutting the belly
'05.08.2018'
Source: Air force
In Russia, for the first time, an operation was performed on the brain of an embryo, without cutting the abdomen of a pregnant woman. The child was born in July, and doctors say that there is no threat to his life. The so-called endoscopic surgery is safer than intervention with a cesarean section. They help with minimal risk to save a child from congenital defects before birth.
The choice in favor of this method of operation was made by doctors at the Ural Research Institute of Maternity and Infancy, when they needed to save an unborn child who was rapidly developing hydrocephalus (or, in other words, dropsy of the brain), says Air force.
As the doctors say, the newborn child will be diagnosed, but there is no longer any danger to life and normal development.
Intrauterine surgery
The fetus can be operated in two ways: using caesarean section and laparoscopy. There are cases when physicians literally had to get the fetus out of the womb to rid it of a tumor, but even such risky steps were justified.
When a caesarean section is performed, the surgeons, as it were, open the abdomen and uterus and bring the fetus itself to the incision, which partially exposes the uterine cavity. It turns out that the child "looks" out.
Laparoscopy is now a common type of surgery, when the intervention occurs without incisions, but only with the help of punctures. The surgeon sees what is happening inside with an endoscope (a flexible tube with a video camera). This method is now used in oncology, gynecology, as well as in the treatment of the gastrointestinal tract and hernias.
An open operation, according to doctors, is much more dangerous for pregnancy than a closed one (that is, a puncture), because after it there is a risk of premature birth.
Endoscopic surgery on the fetus in the womb is a special challenge. Moreover, an operation on the brain of an unborn baby. The main advantage of the endoscopic method is that during it the course of pregnancy is practically not disturbed, Albert Sufianov, the head physician of the Tyumen Federal Center for Neurosurgery, who performed the operation, explained to the BBC.
Save mother
The development of modern fetal surgery (that is, fetal surgery) began actively in the 1980-s, when visualization technologies developed. They made possible prenatal diagnosis: finally, there was an opportunity to see a person before his birth.
Cases when intrauterine surgery is required are quite rare. Therefore, at first, they were reluctant to invest in the development of the necessary technologies and tools. The situation changed after the EU established the Eurofoetus program in 1998.
Hydrocephalus was the first goal of fetal surgery, since it was the embryo's nervous system defects that were one of the main causes of death among pregnant women. Before the prenatal diagnosis was invented, such congenital defects were learned after the uterine rupture had occurred and the woman died.
Initially, the goal of intrauterine operations was to save the mother. The child, as a rule, did not experience such an intervention. To this day, doctors offer future mothers two ways out of the situation: an abortion or an operation that gives hope, but still cannot guarantee one hundred percent that the child will survive.
Have time before birth
The period when the fetus is formed in the womb is key. It determines the future life of the child. Therefore, it is important to have time to correct congenital defects before childbirth.
For example, one of the risks for children with hydrocephalus is that the cerebral cortex will not form at all, as the spinal fluid will take up the entire skull. The child can be saved from it after birth. However, by removing the fluid, doctors run the risk of finding only a brain stem in a child’s head. Such a person will remain handicapped for life.
Moreover, if you do not cope with hydrocephalus in the womb, the child may die at all during childbirth. This risk is the mother.
Modern medicine tries to cure before birth those defects that are associated with the oppression of the natural development of the child.
Dropsy interferes with the development of the brain, and congenital tumors are dangerous because they “suck” all the forces for development from the fetus: they take blood from it.
With fetal fetal transfusion syndrome (occurs during twin pregnancy), one embryo receives a "double portion" of blood, that is, both the one that is intended for him and the one that is intended for the second fetus.
In all these situations, the child, not yet born, is forced to “fight” for life and for his normal existence in the future. The outcome of this struggle is usually predetermined, but surgeons invading the womb of a pregnant mother are seeking to restore justice.
What are surgeons capable of?
According to Sufianov, until recently, only separate elements of neurosurgical operations on the fetus (puncture, suction of fluid) were performed in an endoscopic manner, but no more.
A fully completed operation, similar to that performed by the Ural surgeons, was not yet. Now Russian surgeons are working to ensure that the spinal hernia can be operated on in the same way, said Sufianov in an interview with BBC.
Myelomeningocele (spinal hernia in newborns), along with hydrocephalus, is one of the main candidates for endoscopic treatment inside the womb.
Surgeons already know how to rid children of this congenital defect even during pregnancy with a caesarean section, but there are not so many medical teams in the world that can do this without cutting the uterus.
A couple of years ago there were only two of them: one from the German Center for Fetal Surgery and Minimally Invasive Therapy at the University of Bonn, the other from the Pathology Department of the University of São Paulo in Brazil.
Fetal surgery has already achieved success in treating such severe congenital defects, such as the aforementioned hydrocephalus and spinal hernia, as well as in the treatment of congenital diaphragmatic hernia, feto-fetal transfusion syndrome and sacrocum-borax tumor (whether closed or open method).
