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Narrator: During fetoscopic surgical repair, an incision is made in the abdomen to expose the uterus. Using ultrasound, the location of the placenta is identified to determine safe locations for insertion of the endoscopic trocars. The baby's back is then positioned facing up, and gas or air is added to the uterus to create a uterine environment that's half gas and half amniotic fluid. This allows the baby to float in the amniotic fluid with its back exposed for the procedure.

Two ports are inserted through the wall of the uterus. Through a tiny telescope, the spina bifida defect is visualized. The membrane of the cyst is sharply cut, and the neural placode is released from the surrounding tissue. Then the dura mater and all layers of the muscle and skin are closed over the top of the neural elements, resulting in a watertight seal. The gas is replaced by fluid to maintain the amniotic fluid volume. Finally, the instruments and ports are removed, and the maternal abdomen is closed to complete the procedure.

Dec. 14, 2019