Fetal Interventions: A Closer Look at Fetoscopic Laser Surgery: A Literature Review

• Autor(a) principal: Pereira, Inês de Bastos Marques
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/13566
• topic: Cirurgia Fetal; Cirurgia Fetoscópica a Laser; Fetoscopia; Intervenção Intrauterina; Procedimento Minimamente Invasivo; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Over the past decades, due to the advances in imaging methods, prenatal diagnosis of congenital malformations has become widely available. Simultaneously with the improvement of surgical techniques and the development of instrumentation technology, fetal treatment of these pathologies became possible, arising as an alternative to the standard postnatal therapy, aiming to improve fetal outcomes and optimize the transition into neonatal life. Thus, fetal surgery emerges, comprising open interventions and minimally invasive procedures, such as fetoscopy. Fetoscopic surgery, or fetal endoscopic surgery, is a technique that uses endoscopic technology to correct structural and/or functional fetal anomalies in utero, under continuous ultrasound guidance. Fetoscopy is mainly performed percutaneously and allows direct visualization of the fetus and adjacent structures. Nowadays, fetal surgery is most commonly indicated in the treatment of twinto-twin transfusion syndrome, a complication of monochorionic twin pregnancies, using laser coagulation. However, fetoscopic laser surgery can also be performed for the management of other conditions affecting monochorionic pregnancies, such as twin anemia polycythemia sequence and twin reversed arterial perfusion sequence, as well as several other pathologies including amniotic band syndrome, lower urinary tract obstruction, congenital high airway obstruction syndrome, chorioangiomas, and sacrococcygeal teratomas. The aim of this literature review is to provide a brief overview of the most common fetal interventions and to describe fetoscopic laser surgery, covering its indications, techniques, and outcomes following fetal treatment.