To Mend a Birth Defect, Surgeons Operate on the Patient Within the Patient

Denise Grady in The New York Times:

The patient, still inside his mother’s womb, came into focus on flat screens in a darkened operating room. Fingers, toes, the soles of his feet — all exquisite, all perfectly formed. But not so his lower back. Smooth skin gave way to an opening that should not have been there, a bare oval exposing a white rim of bone and the nerves of the spinal cord. “All right, it’s the real deal,” said Dr. Michael A. Belfort, the chairman of obstetrics and gynecology at Baylor College of Medicine and obstetrician and gynecologist-in-chief of Texas Children’s Hospital.

The fetus, 24 weeks and two days old, less than two pounds, was about to have surgery. He had a severe form of spina bifida, in which the backbone and spinal cord do not develop properly. Children born with this condition usually cannot walk, and suffer from fluid buildup in the brain, lack of bladder control and other complications. A pediatric neurosurgeon, Dr. William Whitehead, joined Dr. Belfort at the operating table. Doctors have been performing fetal surgery to repair spina bifida since the 1990s; it is not a cure, but can lessen the degree of disability. But now Dr. Belfort and Dr. Whitehead are testing a new, experimental technique — one that some in the field are eager to learn, but that others regard warily, questioning its long-term safety for the fetus. The surgeons had made a wide incision in the mother’s lower abdomen, gently lifted out her uterus — still attached internally — and made two tiny, 4-millimeter slits. In one, they inserted a “fetoscope,” a small telescope fitted with a camera, light and grasping tool. The second slit was for other miniature instruments. Lit from within, the uterus glowed, red and magical in the darkened room. Spina bifida occurs early, at three to four weeks of pregnancy, when the tissue forming the spinal column should fold into a tube but does not close properly. There are 1,500 to 2,000 cases a year in the United States.

More here.