Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, February 17, 1994 TAG: 9402170145
SECTION: NATIONAL/INTERNATIONAL PAGE: A10 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Medium
Such surgery represents a "new frontier in fetal medicine" and could provide a new weapon against a variety of abnormalities, doctors said Wednesday.
"There is a parallel in adult surgery - 20 years ago, women were not having hysterectomies through their belly button," said Dr. David Cotton, chief of obstetrics at Wayne State University in Detroit, where the operation, the first successful use of the technique, was performed.
"What you're seeing for the first time is a fetus that has undergone this type of surgery. . . . It poses unlimited possibilities."
Operating on a fetus is extremely rare because of the risks it poses to the mother and baby by opening the womb.
But doctors wondered whether endoscopic surgery - performing operations through needle-sized holes guided by miniature cameras inside the body - would be safer.
Such surgery is becoming commonplace in adults, but had failed repeatedly in fetuses, with the exception of one case in Britain. After four failed attempts that resulted in babies' deaths, those doctors succeeded in unclogging a fetus' heart valve, but called the procedure luck and urged others not to copy it.
But Wayne State obstetrician Dr. Ruben Quintero developed a different technique. On Wednesday, he announced his success by showing a videotape of smiling Santerras Graham, the first baby born after such surgery in the womb.
"It is fair to say you are the first endoscopic fetal surgeon in the world," Dr. Roberto Romero, chief of perinatology for the National Institutes of Health, told Quintero.
Toya Graham, 24, of South Carolina, was diagnosed with a rare defect when she was four months' pregnant. One of her twins had no heart or brain but was being supported by a normal twin whose heart pumped blood for both fetuses. That's too much work for the tiny heart, so the normal twin almost always dies in such cases.
The defect occurs once in every 35,000 pregnancies.
In March, Graham agreed to let Quintero experiment. He inserted tiny instruments through two needle-size holes in her uterus and tied a knot in the malformed twin's umbilical cord. That stopped blood circulating to the abnormal fetus and allowed the normal fetus to develop properly.
In August, Santerras was born.
Quintero credits miniature tools he created for his success. In one endoscope, three times smaller than those used on adults, he inserted a tiny camera. Through the second went tiny scissors to cut the membrane around the abnormal fetus. Then in went something resembling tiny pliers, for tying the knot.
by CNB