Welcome!

News Feed Item

Texas Children's Hospital Fetal Center performs first successful fetoscopic repair to treat spina bifida in the United States

HOUSTON, Sept. 4, 2014 /PRNewswire-USNewswire/ -- Physicians at Texas Children's Fetal Center and Baylor College of Medicine proudly announce the completion of the first two-port fetoscopic procedure to repair spina bifida in-utero. It is believed that this is the first time this type of fetoscopic procedure has been performed in the United States.

The fetoscopic approach was developed by Dr. Michael Belfort, obstetrician and gynecologist-in-chief at Texas Children's Hospital and Dr. William Whitehead, pediatric neurosurgeon at Texas Children's Hospital.  This surgery was over three years in the making and features an in-utero, single layer, sutured repair through only two, four millimeter incisions in the uterus.  A carbon dioxide gas technique was used to aid the physicians during the fetal repair of spina bifida.  The team worked collaboratively with Dr. Jose Luis Peiro and Dr. Elena Carreras of Vall D'Hebron Hospital in Barcelona, Spain.

Myelomeningocele, or open neural tube defect (NTD), is a form of spina bifida that occurs in 3.4 out of every 10,000 live births in the U.S. and is the most common permanently disabling birth defect for which there is no known cure. Myelomeningocele is a developmental defect in which the spine is improperly formed and the spinal cord is exposed and fused with the skin. It is usually associated with hydrocephalus, or the buildup of cerebrospinal fluid in the brain, which requires surgical treatment to drain the fluid via an implanted device called a shunt.  Previously, closure of the defect occurred after the birth of the baby, or in the first days of life, which was associated with an 80-90% chance that a shunt will be required and remains for life. 

The landmark clinical trial, known as the Management of Myelomeningocele Study (MOMS), demonstrated that a fetal surgical repair leads to lower rates of hydrocephalus, decreased the need for a cerebrospinal fluid shunt, and improved leg function compared to standard after-birth repair of this condition. On average, the group treated before birth had better outcomes. Texas Children's Fetal Center adopted this as a treatment option and began open fetal surgery to treat spina bifida in 2011. Texas Children's Fetal Center is among a few centers in the country able to perform this complex in-utero repair and has been successful with their open cases, with the average gestational age at the time of delivery of 34 to 35 weeks. Only 2 of the 23 cases performed at the Texas Children's Fetal Center have required treatment for hydrocephalus. 

The team at Texas Children's Hospital wanted to build upon the success of the MOMS trial by performing the same surgery on the fetus but with a focus on reducing the risks to the mother. The current open fetal surgery technique involves a uterine incision to allow the open surgical repair. This incision may cause maternal complications.  The teams at Texas Children's Fetal Center and Vall D'Hebron Hospital ultimately developed a new way to perform fetoscopic surgery.  A fetoscope is a small telescope and can be combined with tiny instruments allowing surgery inside the uterus without the need for the 5-6cm centimeter opening that is required on the mother's uterus for an open procedure. The new, experimental technique was designed to counter the risks including preterm delivery and poor healing of the uterine scar, as seen with previous attempts.  In addition, this procedure may permit the fetus to be born vaginally, rather than with the c-section required for all other babies with spina bifida.

Years of preparation and training went into developing the program both domestically and internationally. The procedure had been performed on fetal sheep and considered to be technically feasible. Texas Children's Hospital supported the international effort from the beginning. In order to refine this minimally invasive fetoscopic approach, the team built a low-cost simulator using a child's kickball that replicated the mother's uterus. Inside the kickball, a doll covered in chicken-skin acted as the fetus including a spina bifida defect on the doll's back. Drs. Belfort and Whitehead practiced closing the defect using a team approach in which they both carry out specific parts of the surgery in a coordinated fashion. The two surgeons performed more than 30 simulated procedures using the simulator including two full simulations, gowned and gloved under actual OR conditions with a full support team.

With a multi-disciplinary structured program in place, clinical planning and training and full Institutional Review Board approval for this experimental procedure, the team at Texas Children's Hospital performed the in-utero spina bifida fetoscopic closure on their first patient on July 30, 2014. The case went smoothly and so far, the mother and fetus are doing well.

"While we have had a technical success with this procedure, we will only be able to truly know the outcome once the baby has been delivered and we are able to assess the spina bifida repair," says Dr. Whitehead, who is also Assistant Professor of Neurosurgery at Baylor College of Medicine.

"It is important to note that this mother has not been exposed to a significant uterine incision and we are much less concerned about her risk of a ruptured uterus during this pregnancy than we are after an open repair," added Belfort, who is also professor and chairman of the department of obstetrics and gynecology at Baylor College of Medicine. He went on to say that the risks of preterm delivery, the need for cesarean section for every delivery, and the risks of uterine rupture and abnormally adherent placenta (placenta accreta) in subsequent pregnancies after open fetal surgery all make the fetoscopic approach attractive.

In addition to an expert operating room team and nursing staff, a multidisciplinary team of specialists led this first surgery at Texas Children's Fetal Center, including:

  • Dr. Michael Belfort, obstetrician and gynecologist-in-chief at Texas Children's Hospital Pavilion for Women and professor and chairman of the Department of Obstetrics and Gynecology at Baylor College of Medicine
  • Dr. William Whitehead, pediatric neurosurgeon at Texas Children's and assistant professor neurosurgery at Baylor College of Medicine
  • Dr. Alireza Shamshirsaz, maternal fetal specialist at Texas Children's Hospital, and assistant professor, Department of Obstetrics and Gynecology at Baylor College of Medicine
  • Dr. Oluyinka O. Olutoye, pediatric surgeon and co-director of the Texas Children's Fetal Center, and professor of surgery, pediatrics, and obstetrics and gynecology at Baylor College of Medicine
  • Drs. Olutoyin A. Olutoye, and David Mann, pediatric and fetal anesthesiologists at Texas Children's Hospital and Department of Anesthesiology at Baylor College of Medicine
  • Dr. Rodrigo Ruano, maternal fetal specialist and co-director of the Texas Children's Fetal Center, and professor in Department of Obstetrics and Gynecology at Baylor College of Medicine

"Our hope is that these types of innovations will lead us to a new era of fetal medicine and surgery," says Belfort. "Personally, with the ever-advancing technology and imaging capabilities and dedicated surgeons, I am excited to see what the future holds when it comes to repairing anomalies fetoscopically. I am so impressed by what can be achieved with our exceptional team. We look forward to an uneventful delivery and a healthy baby."

Texas Children's Fetal Center is located on the fourth floor of Texas Children's Pavilion for Women and is one of only a handful of facilities in the world to offer a full spectrum of maternal and fetal care. Comprehensive services include management of any complex pregnancy, genetic counseling and the full range of fetal diagnostic procedures. The Fetal Center also provides highly specialized fetal surgeries for a number of congenital malformations. Texas Children's Fetal Center is among the nation's leaders in providing high-risk maternal care and the diagnosis and treatment of abnormalities in unborn and newborn infants.

For more information, please visit women.texaschildrens.org/fetalcenter/

About Texas Children's Hospital
Texas Children's Hospital, a not-for-profit health care organization, is committed to creating a healthier future for children and women throughout the global community by leading in patient care, education and research. Consistently ranked as the best children's hospital in Texas, and among the top in the nation, Texas Children's has garnered widespread recognition for its expertise and breakthroughs in pediatric and women's health. The hospital includes the Jan and Dan Duncan Neurological Research Institute; the Feigin Center for pediatric research; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children's Hospital West Campus, a community hospital in suburban West Houston; and Texas Children's Hospital The Woodlands, a second community hospital planned to open in 2017. The organization also created the nation's first HMO for children, has the largest pediatric primary care network in the country and a global health program that's channeling care to children and women all over the world. Texas Children's Hospital is affiliated with Baylor College of Medicine. For more information, go to www.texaschildrens.org. Get the latest news by visiting the online newsroom and Twitter at twitter.com/texaschildrens.

Contact: Christy Brunton
O: (832) 824-2645 C: (281) 684-3184 
[email protected]

SOURCE Texas Children's Hospital

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
Have you ever noticed how some IT people seem to lead successful, rewarding, and satisfying lives and careers, while others struggle? IT author and speaker Don Crawley uncovered the five principles that successful IT people use to build satisfying lives and careers and he shares them in this fast-paced, thought-provoking webinar. You'll learn the importance of striking a balance with technical skills and people skills, challenge your pre-existing ideas about IT customer service, and gain new in...
In his general session at 18th Cloud Expo, Lee Atchison, Principal Cloud Architect and Advocate at New Relic, discussed cloud as a ‘better data center’ and how it adds new capacity (faster) and improves application availability (redundancy). The cloud is a ‘Dynamic Tool for Dynamic Apps’ and resource allocation is an integral part of your application architecture, so use only the resources you need and allocate /de-allocate resources on the fly.
SYS-CON Events announced today that Hitrons Solutions will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Hitrons Solutions Inc. is distributor in the North American market for unique products and services of small and medium-size businesses, including cloud services and solutions, SEO marketing platforms, and mobile applications.
The Internet of Things will challenge the status quo of how IT and development organizations operate. Or will it? Certainly the fog layer of IoT requires special insights about data ontology, security and transactional integrity. But the developmental challenges are the same: People, Process and Platform. In his session at @ThingsExpo, Craig Sproule, CEO of Metavine, demonstrated how to move beyond today's coding paradigm and shared the must-have mindsets for removing complexity from the develop...
@DevOpsSummit at Cloud taking place June 6-8, 2017, at Javits Center, New York City, is co-located with the 20th International Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The widespread success of cloud computing is driving the DevOps revolution in enterprise IT. Now as never before, development teams must communicate and collaborate in a dynamic, 24/7/365 environment. There is no time to wait for long developm...
For basic one-to-one voice or video calling solutions, WebRTC has proven to be a very powerful technology. Although WebRTC’s core functionality is to provide secure, real-time p2p media streaming, leveraging native platform features and server-side components brings up new communication capabilities for web and native mobile applications, allowing for advanced multi-user use cases such as video broadcasting, conferencing, and media recording.
Almost two-thirds of companies either have or soon will have IoT as the backbone of their business. Though, IoT is far more complex than most firms expected with a majority of IoT projects having failed. How can you not get trapped in the pitfalls? In his session at @ThingsExpo, Tony Shan, Chief IoTologist at Wipro, will introduce a holistic method of IoTification, which is the process of IoTifying the existing technology portfolios and business models to adopt and leverage IoT. He will delve in...
In his session at @ThingsExpo, Steve Wilkes, CTO and founder of Striim, will delve into four enterprise-scale, business-critical case studies where streaming analytics serves as the key to enabling real-time data integration and right-time insights in hybrid cloud, IoT, and fog computing environments. As part of this discussion, he will also present a demo based on its partnership with Fujitsu, highlighting their technologies in a healthcare IoT use-case. The demo showcases the tracking of patie...
DevOps and microservices are permeating software engineering teams broadly, whether these teams are in pure software shops but happen to run a business, such Uber and Airbnb, or in companies that rely heavily on software to run more traditional business, such as financial firms or high-end manufacturers. Microservices and DevOps have created software development and therefore business speed and agility benefits, but they have also created problems; specifically, they have created software securi...
In today's enterprise, digital transformation represents organizational change even more so than technology change, as customer preferences and behavior drive end-to-end transformation across lines of business as well as IT. To capitalize on the ubiquitous disruption driving this transformation, companies must be able to innovate at an increasingly rapid pace. Traditional approaches for driving innovation are now woefully inadequate for keeping up with the breadth of disruption and change facing...
SYS-CON Events announced today that Outlyer, a monitoring service for DevOps and operations teams, has been named “Bronze Sponsor” of SYS-CON's 20th International Cloud Expo®, which will take place on June 6-8, 2017, at the Javits Center in New York City, NY. Outlyer is a monitoring service for DevOps and Operations teams running Cloud, SaaS, Microservices and IoT deployments. Designed for today's dynamic environments that need beyond cloud-scale monitoring, we make monitoring effortless so you...
Addteq is one of the top 10 Platinum Atlassian Experts who specialize in DevOps, custom and continuous integration, automation, plugin development, and consulting for midsize and global firms. Addteq firmly believes that automation is essential for successful software releases. Addteq centers its products and services around this fundamentally unique approach to delivering complete software release management solutions. With a combination of Addteq's services and our extensive list of partners,...
Cloud Expo, Inc. has announced today that Andi Mann and Aruna Ravichandran have been named Co-Chairs of @DevOpsSummit at Cloud Expo 2017. The @DevOpsSummit at Cloud Expo New York will take place on June 6-8, 2017, at the Javits Center in New York City, New York, and @DevOpsSummit at Cloud Expo Silicon Valley will take place Oct. 31-Nov. 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
Stratoscale, the software company developing the next generation data center operating system, exhibited at SYS-CON's 18th International Cloud Expo®, which took place at the Javits Center in New York City, NY, in June 2016.Stratoscale is revolutionizing the data center with a zero-to-cloud-in-minutes solution. With Stratoscale’s hardware-agnostic, Software Defined Data Center (SDDC) solution to store everything, run anything and scale everywhere, IT is empowered to take control of their data ce...
Tricky charts and visually deceptive graphs often make a case for the impact IT performance has on business. The debate isn't around the obvious; of course, IT performance metrics like website load time influence business metrics such as conversions and revenue. Rather, this presentation will explore various data analysis concepts to understand how, and how not to, assert such correlations. In his session at 20th Cloud Expo, Leo Vasiliou, Director of Web Performance Engineering at Catchpoint Sys...