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WJOLS
Current Status of Minimal Access Surgery (MAS) in the Field of Maternal-Fetal Medicine
REVIEW ARTICLE
Current Status of Minimal Access Surgery (MAS)

in the Field of Maternal-Fetal Medicine

HL Chauke

Maternal and Fetal Medicine (Specialist/Lecturer), Department of Obstetrics and Gynecology, Kalafong Hospital and University
of Pretoria, South Africa, Member, International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), World Association
of Laparoscopic Surgeons (WALS)

Correspondence: HL Chauke, Maternal and Fetal Medicine (Specialist/Lecturer), Department of Obstetrics and Gynecology
Kalafong Hospital and University of Pretoria, South Africa, e-mail: chaukehl@telkomsa.net

Abstract
Minimal access surgery has had resounding impact in the practice of surgery. The advantages include less scarring, quick recovery
and return to work. It is not surprising that this field has received attention in the practice of fetal surgery as clinicians were faced with
considerable complications inherent in open surgical procedures. The field has evolved, skills refined and technology improved, allowing
management of selected fetal conditions through minimal access into the uterine cavity and the fetus. There is however, challenges that
needs to be addressed. Open surgery cannot be relegated to history books at this stage and the two approaches have specific
indications and are complementary.
Keywords: Laparoscopy in pregnancy, MAS in fetal medicine, maternal fetal medicine and laparoscopy.

INTRODUCTION instruments and manipulating them inside the uterine cavity
was viewed as similar to playing video games, hence the
Advances in medical imaging have led to an improvement
name). Other groups like the children’s hospital of
in prenatal diagnosis of congenital anomalies. This has been
Philadelphia (CHOP), and the fetal center at Leuven, etc
made possible through the incorporation of new ultrasound 2
joined suite. There are now few specialized centers in
technologies, use of doppler and real time imaging. These
different countries dedicated to this cause. The end result
have resulted in improvement in resolution and quality of has been research and refinement of skills as new knowledge
ultrasound images. Concurrent use l Magnetic Resonance is acquired. The observation that postnatal therapy was
4-6
Imaging (MRI) in fetal imaging has resulted in better not the answer to all fetuses, has led to the emergence of
definition of pathology and diagnosis in situation where fetal surgery over the last 30 years. The vision has been an
1
ultrasound imaging turns to be inconclusive. Together with attempt to salvage the few fetuses with conditions that are
the accolades gained by medical science in the understanding known to result in stillbirth if left untreated, arrest the
of the pathophysiological basis of diseases, clinicians have pathophysiological process or reverse fetal damage that is
never been better equipped in making accurate diagnosis not amenable to postnatal correction. Currently three
and better positioned in counselling their patients regarding approaches are available for intrauterine management of fetal
conditions, open approach via hysterotomy or minimal
prognosis and options available for the fetal condition in
access using endoscopy or Fetal Image Guided Surgery
question, as is the case now. 6
(FIGS). The latter approach is what is generally referred
Sir William Albert Liley is regarded as the ‘father of
to as percutaneous approach. This procedure uses needles
fetal medicine’. His successful intrauterine transfusion of
to access the fetus under ultrasound guidance. Fetal surgery
fetus affected by Rhesus disease in New Zealand, in 1963,
has undergone evolution from the first successful intrauterine
opened a multitude of possibilities and opportunities for fetal transfusion in New Zealand, hysterotomy for vascular
medicine specialists. 2,3 This has been followed by different access and intrauterine transfusion (Puerto Rico, 1964),
developments, animal studies and refining of skills. The Fetal diagnostic fetoscopy (Yale, 1974), Laser ablation of
treatment center at the University of California, San placental vessels (Milwaukee, London,1995) right to the
Francisco (UCSF), under the leadership of Michael Harrison use of amniotic collagen plug (Leuven, 2007) and sclero-
(a pediatric surgeon by training), has been at the forefront therapy for congenital cystic adenomatous malformation
4
of this development. This center has been in limelight for (CCAM) performed in Venezuela in 2007. A comprehensive
performing fetal open fetal surgery and later inversion of review of these milestones is well articulated in the article
minimal fetal approach dubbed ‘FETENDO’ (use of small by Jancelewicz and Harrison. 2

World Journal of Laparoscopic Surgery, January-April 2010;3(1):1-6 1