Colin G. Knight, M.D.; Attila Lorincz, M.D. ;Anthony Johnson, D.O.; Kelly Gidell, R.N., B.S.N.; Rajah Rabah, M.D.; Michael D. Klein, M.D.; Scott E. Langenburg, M.D.

Abstract

Background: Fetoscopic surgery carries with it less maternal morbidity than open fetal surgery. Robotic surgery facilitates endoscopic surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. Our goal was to apply these advantages to fetoscopic surgery in an animal model.

Methods: Using the Zeus Robotic Surgery System, we performed fetoscopic surgery in pregnant sheep using a variety of techniques: uterus exteriorized or totally percutaneous, and with liquid or gas insufflation. Using the percutaneous technique and gas insufflation, we created and sutured fetal skin and fascial defects. We recovered the ewes, euthanized them two weeks postoperatively, and autopsied them and their fetuses.

Results: In the exteriorized uterus model, instrument movement was unpredictable and fluid leaked. In the fluid environment, clouding of the visual field and difficulty in immobilizing the fetus were major difficulties. In the survival model, four of the six fetuses survived to autopsy at two weeks and demonstrated good healing grossly and histologically.

Conclusions: The Zeus Robotic Surgery System can be used for fetoscopic surgery in a sheep model. The percutaneous approach with a nitrous oxide environment is the most effective. The advantages of robotic surgery can be applied to fetoscopic surgery and may broaden the range of feasible intrauterine interventions.



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