Article Outline

• Reference
• Copyright

Technological advances have given clinicians a window into the womb, which allows for the diagnosis as well as treatment of fetal abnormalities. With diagnostic advances such as ultrasonography, computed tomography, and magnetic resonance imaging, the ability to detect fetal anomalies has increased. Since the early 1990s, advances in endoscopic equipment and the commercial availability of microcatheters, miniballoons, and tiny laser fibers have set the trend toward the development of minimally invasive fetoscopic surgical techniques for the treatment of some congenital malformations that progress in severity over the course of gestation and may destroy the entire organ systems of the unborn fetus. Likewise, advances in hysteroscopy and open hysterotomy for in utero intervention have been established. For a fetus diagnosed with a severe congenital anomaly, surgery may offer an alternative to abortion, intrauterine death, or a life with disability.

The treatment of a fetus with an anomaly that is potentially correctable is complicated by the potential for harm to the mother. With regards to all fetal interventions, maternal safety is paramount. Until recently, only fetal malformations that were likely to result in in utero or postnatal demise were considered for fetal surgery because of the potential risks to the mother.

Fetal surgery is a rapidly growing multidisciplinary field. Expertise is limited, however, to a few treatment centers worldwide, and there are many technical hurdles to overcome. There have been several initiatives to integrate robotics into the fetal operating room, recently coined “febotics.”¹

In the last decade, the fetus has become a patient. As the field of fetal surgery expands, practitioners must remain dedicated to rigorous scientific quality assurance to evaluate the risk-benefit ratio for the fetus and mother. Innovative technologies may be changing the roles of patients and health practitioners, and raising new issues including ethical, legal, and social dilemmas, many of which are discussed in this issue of Newborn and Infant Nursing Reviews. Dr Barbara Warner, neonatologist and guest editor of this issue, helped initiate and coordinate the first fetal therapeutic program in Cincinnati, Ohio.

Back to Article Outline

Reference 

1. Berris M, Shoham M. Febotics—a marriage of fetal surgery and robotics. Comput Aided Surg. 2006;11:175–180
   • View In Article
   • MEDLINE
   • CrossRef