Teaching and training the total percutaneous fetoscopic myelomeningocele repair

Tuangsit Wataganara; Lucas Trigo; Denise Araujo Lapa

doi:10.1515/jpm-2020-0591

Article

Teaching and training the total percutaneous fetoscopic myelomeningocele repair

Tuangsit Wataganara , Lucas Trigo and Denise Araujo Lapa

Published/Copyright: April 5, 2021

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From the journal Journal of Perinatal Medicine Volume 49 Issue 7

Abstract

Skin-over-biocellulose for Antenatal Fetoscopic Repair (SAFER) is a recently developed technique for fully percutaneous fetoscopic repair of myelomeningocele. The formation of a neo-dura mater triggered by the use of a biocellulose patch over the placode obviates the need of primary repair of fetal dura mater, and seems to further improve neurodevelopmental outcome. Insufflation of humidified carbon dioxide into the amniotic cavity requires proper training and a different equipment set from those used in the classic “under-water” fetoscopy. To shorten the learning curve of novice teams, we have developed a structured training course encompassing three critical steps: (1) visiting the proctor center, (2) selection of the first case, and (3) on-site training of the surgical team. Upon the site arrival, there will be: (1) theoretical lecture for all specialists involved in the fetal care, (2) simulation training, and (3) surgical proctoring. Proctor team can take over the surgery if the local team cannot complete. This training course has been successfully used in five different countries: Israel, Chile, Italy, USA and England and all local teams are already performing surgeries solo without any failures or maternal morbidity. Teaching new procedures in fetal medicine is challenging, because of the small number of candidate cases, and the direct relation of good outcomes and the number of cases operated. This proposed training modules may be adopted by other teams that want to embark on this type of novel minimally invasive treatment.

Keywords: fetal surgery; fetoscopy; myelomeningocele; rachischisis

Corresponding author: Denise Araujo Lapa, MD, PhD, Hospital Infantil Sabara – Head Fetal and Neonatal Therapy Team, Hospital Israelita Albert Einstein, Fetal Therapy Program, Av. Albert Einstein, 627 – Bloco C 5º andar, São Paulo, SP, Brazil, Phone: +55 11 984731574, E-mail: denise.araujo.lapa@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Ethical approval: All materials obtained for writing of this manuscript were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version).

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Received: 2020-12-14

Accepted: 2021-02-08

Published Online: 2021-04-05

Published in Print: 2021-09-27

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Articles in the same Issue

https://doi.org/10.1515/jpm-2020-0591

Keywords for this article

fetal surgery; fetoscopy; myelomeningocele; rachischisis