ABSTRACT
Lethal Anomaly 52
4. Obstructive Uropathy 54
5. Sacrococcygeal Teratoma 60
6. Myelomeningocele 62
7. Tension Hydrothorax 63
8. Congenital Heart Defects 65
9. Premature Rupture of Membranes 68
10. Amniotic Band Syndrome 69
11. Gastroschisis 69
12. Potential Future Applications of Minimal Access Fetal
Surgical Technique 70
References 71
The rapid advances over the last 20 years in prenatal imaging and diagnosis, coupled with
an increased understanding of the pathogenesis of neonatal disease, has led to the identi-
fication of the fetus as a patient and to the burgeoning field of fetal surgery. An increasing
number of select fetal anomalies are currently amenable to prenatal intervention
(Table 5.1). Life-threatening congenital anomalies have been historically treated by
open fetal surgical techniques. Yet, a variety of significant complications including pre-
term labor (PTL), premature rupture of membranes (PROM), pre-term delivery and
maternal complications from the tocolytic therapy have lead surgeons to investigate inno-
vative approaches to minimize these complications. In order to reduce maternal morbidity
related to the hysterotomy and fetal morbidity due to exposure and manipulation, minimal
access surgical techniques have been adapted to the fetal environs. Minimal access fetal
surgery (MAFS) may allow for a broader applicability of fetal intervention, and extension
of treatment to nonlethal and highly morbid fetal maladies.