A pioneering new form of surgery has been developed that allows doctors to operate on a foetus whilst still in its mother’s womb. The experimental technique is designed to reverse the effects of spina bifida and was recently carried out on a 24-week-old foetus at the Texas Children’s Hospital in Houston. It is hoped this revolutionary procedure could one day help improve the lives of the thousands of babies born with this birth defect every year.
Spina bifida is a condition where the backbone and spinal cord do not develop properly in the womb. Though scientists are not entirely sure what causes these neural tube defects (birth defects of the brain, spine or spinal cord) to occur, they do know the conditions develop during the very early stages of pregnancy, often before the mother is even aware they are pregnant.
As well as leading to complications during the pregnancy, such as traumatic birth, spina bifida can severely affect the quality of life for those born with the condition. Symptoms are varied, but can include nerve damage, issues with bladder control and paralysis of the legs. Some will also develop excess fluid on the brain, which can lead to lifelong learning difficulties.
Typically, surgeons have to operate on the child within 48 hours of birth. However, doctors can only repair the defect and cannot reverse any damage to the nervous system or brain. Only around 20% of patients who have this type of operation will be able to walk independently.
The male foetus that was operated on at the Texas Children’s Hospital had a severe case of spina bifida. The defect was causing the brain stem to be pulled down the spinal column in such a way that when born the child would never be able to walk, and in all likelihood, would be reliant on breathing and feeding tubes throughout their entire life.
Performing surgical correction before birth, however, can significantly improve survival rates and reduce life-time disability. Prenatal surgery for spina bifida was initially developed in the nineties, though it was only first carried out on the NHS in 2011. The original procedure has to cut open the women’s uterus to reach the foetus, but this can place both patients at increased risks.
The new technique, however, is less invasive, and involves removing the uterus – whilst it is still attached internally – from the patient. Doctors then make two small four-millimetre slits to insert surgical equipment. The amniotic fluid is drained from the uterus and carbon dioxide pumped in to keep it expanded.
Surgeons use a small telescope – called a ‘fetoscope’ – fitted with a camera, light and grasping tool to operate on the foetus within. Once the corrective surgery is complete, doctors replace the amniotic fluid with saline and return the uterus to the patient’s body.
The glowing red orb you can see in the surgeons' hands looks almost magical, yet even more impressive, is what’s going on inside.
A truly remarkable photograph was taken of the surgeons holding the uterus as the fetoscope illuminates it from within – unfortunately we don't have the rights to post it here, but you can easily find it in a search engine. The glowing red orb you can see in the surgeons' hands looks almost magical, yet even more impressive, is what’s going on inside.
In that delicate sphere there is a foetus weighing no more than two pounds, but complete with tiny little fingers and toes, having surgery that could change his life before he is even born.
The operation went well – like the other 28 experimental procedures that were reported on in the Obstetrics and Gynaecology journal in August – but only time will tell how successful it really is.
The due date for this little guy is 14 January. Hopefully when he comes into the world, he’ll have a full life ahead of him.