Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos)

Samuel A. Giday, Jonathan M. Buscaglia, Janyne Althaus, Gianfranco Donatelli, Devi M. Krishnamurty, Xavier Dray, Dawn Ruben, David Liang, Ronald Wroblewski, Priscilla Magno, Eun Shin, Anthony N Kalloo

Research output: Contribution to journalArticle

Abstract

Background: Despite advances in the development of fetal surgery, morbidity and mortality are substantial. A natural orifice transluminal endoscopic surgery (NOTES)-guided approach to the gravid uterus may offer a less-invasive technique. Objective: To assess the feasibility of NOTES for diagnostic and therapeutic intrauterine fetal interventions. Setting: Survival and nonsurvival experiments on pregnant sheep. Design and Intervention: Nonsurvival experiments performed in 2 pregnant sheep (80-110 days' gestation). A third ewe underwent NOTES and survived for 4 weeks. Transgastric (nonsurvival ewes) and transvaginal (1 nonsurvival and the survived ewe) peritoneoscopy was performed after standard needle-knife entry into the peritoneal cavity. Endoscopic access to the gravid uterus was assessed. EUS-guided, transuterine injection of saline solution into the fetal cardiac ventricle and vessels was attempted in all. Main Outcome Measurements: Feasibility of NOTES- and EUS-guided intervention in a pregnant animal model, visibility of fetal parts via EUS compared with transabdominal US. Results: Entry into the peritoneal cavity was achieved in each ewe. Access to and complete visualization of the gravid uterus were successful once within the abdominal cavity. Visualization of the fetal parts and the placental cotyledons by EUS was achieved in all animals. EUS-guided amniocenteses and transuterine intracardiac and intravascular injection of saline were successful. There were no complications or preterm delivery after the procedures. Limitations: Animal model. Conclusions: NOTES is technically feasible in the pregnant ewe. Intraperitoneal EUS via a NOTES approach provides excellent access and visualization of the intrauterine cavity and fetal parts.

Original languageEnglish (US)
Pages (from-to)377-381
Number of pages5
JournalGastrointestinal Endoscopy
Volume70
Issue number2
DOIs
StatePublished - Aug 2009

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Natural Orifice Endoscopic Surgery
Uterus
Peritoneal Cavity
Sheep
Therapeutics
Animal Models
Injections
Amniocentesis
Abdominal Cavity
Cotyledon
Fetal Development
Sodium Chloride
Laparoscopy
Heart Ventricles
Needles
Morbidity
Pregnancy
Mortality

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos). / Giday, Samuel A.; Buscaglia, Jonathan M.; Althaus, Janyne; Donatelli, Gianfranco; Krishnamurty, Devi M.; Dray, Xavier; Ruben, Dawn; Liang, David; Wroblewski, Ronald; Magno, Priscilla; Shin, Eun; Kalloo, Anthony N.

In: Gastrointestinal Endoscopy, Vol. 70, No. 2, 08.2009, p. 377-381.

Research output: Contribution to journalArticle

Giday, SA, Buscaglia, JM, Althaus, J, Donatelli, G, Krishnamurty, DM, Dray, X, Ruben, D, Liang, D, Wroblewski, R, Magno, P, Shin, E & Kalloo, AN 2009, 'Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos)', Gastrointestinal Endoscopy, vol. 70, no. 2, pp. 377-381. https://doi.org/10.1016/j.gie.2009.03.022
Giday, Samuel A. ; Buscaglia, Jonathan M. ; Althaus, Janyne ; Donatelli, Gianfranco ; Krishnamurty, Devi M. ; Dray, Xavier ; Ruben, Dawn ; Liang, David ; Wroblewski, Ronald ; Magno, Priscilla ; Shin, Eun ; Kalloo, Anthony N. / Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos). In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 2. pp. 377-381.
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AU - Krishnamurty, Devi M.

AU - Dray, Xavier

AU - Ruben, Dawn

AU - Liang, David

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AU - Kalloo, Anthony N

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