Keyhole surgery using engineered solutions reduces risk to baby while improving chances of walking
Surgeons at King’s College Hospital in London have carried out repairs on the spine of a baby with spina bifida while it was still in the womb for the first time in the UK. The neurosurgical team, led by consultant Bassel Zebian, used ultrasound to guide the operation on Sherrie Sharp, who was in the 27th week of her pregnancy. Sherrie gave birth to her son, Jaxson, on 20th April, after 33 weeks of pregnancy and he is continuing to recover well.
Spina bifida is a developmental condition in which the spine does not form properly in the womb, leaving the spinal-cord exposed and vulnerable to damage, which can lead to leg paralysis and problems with bladder and bowel control. Previously. Women carrying babies with spina bifida have had two options: surgical repair of the hole in the baby’s back following birth, or an invasive procedure involving an incision across the width of the abdomen to repair the defect. This major surgery carries considerable risks to both the woman and the baby. Keyhole surgery is less traumatic for both patients, particularly in terms of damage to the baby’s nerves, and recovery should therefore be quicker and easier.
The operation, which was pioneered by Dr Denise Lapa Pedreira of the Albert Einstein Hospital in São Paulo, involves introducing a device called a fetoscope – a long, thin tube with a light and camera at the end – into the patient’s uterus through a small incision. More specialised surgical equipment is then inserted to free the exposed spinal cord from surrounding tissue and push it back into its correct location. The surgeons then use a special patch to cover the spinal-cord, close the muscles and skin over it to prevent spinal fluid from leaking, retract the instruments and close the incision in the mother’s abdomen.
“A number of centres around the world have made great strides in open foetal repair over the last few years and demonstrated the benefit of fetal surgery in reducing the severity of the condition and associated complications,” commented Mr Zebian. “The aim of the fetoscopic approach is to reduce the risks to the mother and future pregnancies whilst still ensuring maximal benefit for the baby.” Mr Zebian stressed that the operation is not a cure, but can lead to significant improvement in a significant number of patients.
Dr Lapa Pedreira assisted with the training of the King’s team and it continues to work closely with them, said Dr Marta Santorum-Pérez, King’s consultant in foetal medicine. “Only a handful of centres around the world have the required expertise to perform surgery using a foetoscope,” she said.
By coincidence, Sherrie was herself the recipient of King’s expertise before she was born: suffering from severe anaemia, she received blood transfusions through her mother’s abdomen. As a result of this, she referred herself to Kings when she found out that her baby had spina bifida. “I’m here today thanks to the specialists at King’s so I wanted my baby to have the same chance. The procedure took over three hours and the specialists were happy with how it went. We’re thrilled with our beautiful boy and even though he arrived earlier than expected he’s doing well and his back is healing nicely.”