5 July 2022

Minimally invasive fetoscopic surgery is a rising medical technology to treat the unborn child, however there is an urgent need to reduce the risks introduced by the surgery. The Plugging the Gap project focusses on a new approach to this problem and the first results were recently published.

For each surgery all benefits and risks have to be considered to make the correct decision. Where this is an easy choice for some surgeries, in other cases there is a stricter balance due to a high risk of potential harms. Unfortunately, fetoscopic surgeries belong to the last category.

Fetoscopic surgeries make it possible to treat unborn children with severe conditions, such as twin to twin transfusion syndrome (TTTS), twin reversed arterial perfusion (TRAP) and congenital diaphragmatic hernia (CDH). To perform the surgery, a small defect (Ø 3 mm) is made with a fetoscope in the maternal abdominal wall, uterus and membranes surrounding the fetus. Although fetoscopy has many advantages, the fetoscopic defect in the fetal membranes does not spontaneously heal, cannot be sutured and introduces a high risk of about 30% for early rupture of the membranes. This is also known as iatrogenic preterm prelabor rupture of the membranes (iPPROM), which is a strong trigger for preterm birth and is considered the achilles heel of fetal endoscopic surgery.

For this reason, Rob Meuwese, Toin van Kuppevelt, Willeke Daamen and colleagues, theme Reconstructive & Regenerative Medicine, worked on a new technique to seal the fetal membranes, which is now published in Bioactive Materials (IF2021 16.8). In this study,  they present a collagen plug with shape memory designed to fit through fetoscopic instruments that will directly expand upon placement to seal the membranes.

In the 6-year ZonMw and Health~Holland project, this technique will be studied more in-depth, also including a clinical trial in cooperation with the Dept. of Obstetrics & Gynecology and Dept. for Health Evidence of the Radboudumc, the ErasmusMC, University Hospital Leuven, HCM Medical and several patient organizations.

"A collagen plug with shape memory to seal iatrogenic fetal membrane defects after fetoscopic surgery." Bioactive Materials 20: 463-471.

Meuwese, R. T. C., E. M. M. Versteeg, J. van Drongelen, D. de Hoog, D. Bouwhuis, F. P. H. A. Vandenbussche, T. H. van Kuppevelt and W. F. Daamen (2023).

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