The intrauterine operation is performed under local or epidural anesthesia. It is in principle performed endoscopically. Guided by the ultrasound, the surgeon introduces a trocar (large needle) into the mother’s womb, which contains both a telescope, an instrument or a laser fiber in order to be able to operate. Endoscopy allows live viewing on a screen the placenta and thus guide the surgical instruments. In general, the mother is hospitalized for 24 hours. She will need to rest for the next few days.
In utero surgery: possible interventions
The transfusion-transfused syndrome
The transfusion-transfused syndrome is today the most widespread indication and for which we observe the most satisfactory results. This disease affects 15% of monocorial pregnancies (twins or triplets who share the same placenta), i.e. approximately 1 in 1 pregnancies. This syndrome is characterized by an imbalance in blood exchange between the two fetuses. To remedy this, the surgeon coagulates the abnormal vessels with a laser fiber.
Diaphragmatic hernia
Congenital diaphragmatic hernia is a defect in the development of the diaphragm (presence of a hole) that affects approximately 1 in 2200 births. This malformation causes the abdominal organs to rise up into the chest and compress the lungs. To counteract this effect, surgeons temporarily (until the 34th week) place a small balloon in the trachea to hyper stimulate lung growth. It is therefore only after birth that the hernia is operated. This intervention takes place around the 28th week of pregnancy.
Heart surgery
Sometimes valve stenosis or pulmonary stenosis is detected which, if allowed to develop in utero, can lead to hypoplasia of the heart. When you spot them early enough, you can unclog the valve with a small needle so that the flow continues to pass and make the heart grow bigger. In France, this technique is only performed at Necker Hospital.