Investigators using NOTES(TM) have found for the first time that it can look at the entire uterus and reach areas that had not previously been accessible. The findings, presented at Digestive Disease Week 2008, are important because the morbidity and mortality of fetal surgery is substantial.
If the fetus requires lifesaving surgery, the only way to operate previously was through traditional laparoscopy or laparotomy. But this method is limiting because the uterus and the fetus can only be accessed from the front; unless a doctor is aiming to intervene right beneath the abdominal wall, it would be difficult to access the desired organ. However, using flexible endoscopy, doctors can reach almost any part of the uterus, regardless of the direction the fetus is facing. Furthermore, the procedure could be particularly helpful since it provides a minimally invasive approach to performing fetal surgery.
Researchers performed transgastric peritonoscopy on one ewe and transvaginal peritonoscopy on another following standard needle-knife entry into the abdominal cavity. Access to the uterus was assessed with both a forward-viewing endoscope and a linear-array echoendoscope. Visibility of the fetal areas via endoscopic ultrasound (EUS) was directly compared to transabdominal ultrasound. EUS-guided, transuterine injection of saline into the fetal cardiac ventricle was attempted in both sheep using a 22-gauge fine needle aspiration needle.
Investigators found that access to and complete visualization of the uterus were successful with both endoscopes using an anterior, posterior and lateral approach once inside the abdominal cavity. Also, visualization of the fetal parts by EUS was impressive and superior to transabdominal ultrasound.
“Our findings suggest that NOTES may provide an avenue through which one can ultimately stage even more complicated operations in pregnant women and the fetus,” said Samuel A. Giday, MD, assistant professor of medicine at Johns Hopkins University School of Medicine division of gastroenterology and hepatology.
