Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
Paediatric research and surgery - Journals gselva739
This journals about the laparoscopy in paediatric surgery- Dr. Prakash Agarwal has sharing the experience in SRMC. He explanied paddiatric surgery and its diagnosis and procedure for analysis of children who underwent laparoscopy surgery.
There are several risks associated with poor colorectal lesion localization, the most significant being wrong site surgery. Endoscopic tattooing can help mitigate these risks with an easy, fast method for the gastroenterologist to employ and a clear, precise marker for the surgeon to visualize.
Mount Sinai Otolaryngology Specialty Report 2018Lisa Chase
Peruse Mount Sinai's Department of Otolaryngology - Head and Neck Surgery's annual Specialty Report, featuring endoscopic glomus tumor removal, transgender surgeries, virtual reality for students and surgeons and an innovative surgical technique for vascular malformation removal.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy in Evaluation of Uterine Cavity in Patients with Infertility and Recurrent Pregnancy Loss
Current Role of Surgery in Endometriosis; Indications and ProgressCrimsonpublisherssmoaj
Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.
The introduction of canaloplasty into the glaucoma surgical armamentarium was motivated by the desire of clinicians to enhance the quality of patients’ glaucoma care. Patients’ long-term adherence to topical glaucoma medical therapy is well known to be relatively poor. Laser therapy offers a safe alternative to medical therapy but often still requires the addition of topical medication. Traditionally, glaucoma filtration surgery has been reserved for more advanced, uncontrolled glaucoma for obvious reasons. Despite its definite role in glaucoma care, patients undergoing standard trabeculectomy are at significant risk for the development of postoperative infection, cataract, hypotony, bleb dysesthesia, astigmatism, and decreased visual acuity. These potential complications have driven surgeons to pursue surgical alternatives. Canaloplasty is a well-established procedure that has, for the past 3 years, demonstrated impressive efficacy and safety in peer-reviewed prospective studies. Despite growing evidence of its value and increasing performance of the procedure by ophthalmologists all over the world, misconceptions regarding its long-term efficacy as well as challenges in its adoption, surgical
technique, and patient selection persist. Several experienced and leading surgeons share their experiences and pearls for optimizing success with canaloplasty.
— Steven D. Vold, MD
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Paediatric research and surgery - Journals gselva739
This journals about the laparoscopy in paediatric surgery- Dr. Prakash Agarwal has sharing the experience in SRMC. He explanied paddiatric surgery and its diagnosis and procedure for analysis of children who underwent laparoscopy surgery.
There are several risks associated with poor colorectal lesion localization, the most significant being wrong site surgery. Endoscopic tattooing can help mitigate these risks with an easy, fast method for the gastroenterologist to employ and a clear, precise marker for the surgeon to visualize.
Mount Sinai Otolaryngology Specialty Report 2018Lisa Chase
Peruse Mount Sinai's Department of Otolaryngology - Head and Neck Surgery's annual Specialty Report, featuring endoscopic glomus tumor removal, transgender surgeries, virtual reality for students and surgeons and an innovative surgical technique for vascular malformation removal.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy in Evaluation of Uterine Cavity in Patients with Infertility and Recurrent Pregnancy Loss
Current Role of Surgery in Endometriosis; Indications and ProgressCrimsonpublisherssmoaj
Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.
The introduction of canaloplasty into the glaucoma surgical armamentarium was motivated by the desire of clinicians to enhance the quality of patients’ glaucoma care. Patients’ long-term adherence to topical glaucoma medical therapy is well known to be relatively poor. Laser therapy offers a safe alternative to medical therapy but often still requires the addition of topical medication. Traditionally, glaucoma filtration surgery has been reserved for more advanced, uncontrolled glaucoma for obvious reasons. Despite its definite role in glaucoma care, patients undergoing standard trabeculectomy are at significant risk for the development of postoperative infection, cataract, hypotony, bleb dysesthesia, astigmatism, and decreased visual acuity. These potential complications have driven surgeons to pursue surgical alternatives. Canaloplasty is a well-established procedure that has, for the past 3 years, demonstrated impressive efficacy and safety in peer-reviewed prospective studies. Despite growing evidence of its value and increasing performance of the procedure by ophthalmologists all over the world, misconceptions regarding its long-term efficacy as well as challenges in its adoption, surgical
technique, and patient selection persist. Several experienced and leading surgeons share their experiences and pearls for optimizing success with canaloplasty.
— Steven D. Vold, MD
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Reliability, accuracy and cost effectiveness of prenatal screeningRustem Celami
Dr. Genc Kabili, Dr. Rustem Celami
A scientific paper in prenatal care
Prenatal screening, genetic abnormalities, reliability, accuracy, cost-effectiveness
Colour Doppler ultrasound in controlled ovarian stimulation with Intrauterine...Apollo Hospitals
To assess the endometrial receptivity in terms of endometrial thickness and vascularity and to assess the
potential relationship between perifollicular vascularity following ovulation inducing drugs and outcome in intrauterine insemination (IUI) using the Doppler ultrasonography.
A comparative study of fine needle aspiration cytology, trucut biopsy and his...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. The art of fetoscopy: a step toward minimally invasive fetal therapy
To study the feasibility,learning curve, and safety of fetoscopy, so that fetal surgerycan be confidently performed
in ongoing pregnancies.
Methods
Fetoscopy was performed at12–20 weeks ofgestation,in 12 women with fetal congenital malformations and/or
for termination ofpregnancy, under local anesthesia using fine fetoscopes ranging from 1 to 2-mm diameter.The
fetal parts and placenta were examined for clarity of vision, identification,and anomalies.
Results
Fetoscopy required greatskill,patience,and extensive use of ultrasound for correct orientation.Visualization was
better with endoscope of2-mm diameter.Laser coagulation ofplacental vessels using diode laser system was
possible in the lasttwo cases.There were no major complications.
Starting fetoscopyin the department,learning and establishing the very skillful and potentiallydangerous
procedure before performing fetal endoscopic surgeryin ongoing pregnancies posed unique challenges:
operating theater and personnel requirements,endoscopic techniques,fetoscopic instruments,and technical
expertise in the field.We selected the bestcompromise between image qualityand minimal invasiveness a nd
experienced a natural evolution of learning and modification offetoscopic techniques.
Visualization and observations improved with practice—the oft-quoted “learning curve.” Fetoscopy required great
skill,patience,and extensive repeated use of ultrasound for correct orientation ofthe fetal parts such as mouth,
eyes, limbs,and placental position with fetoscope in utero in the initial four cases with finer fetoscopes and in the
next 3–4 cases with the 2 mm endoscope.In the lastfour cases,we performed the procedures quite expertly; in
2 of these,we tried and could perform laser coagulation ofplacental vessels with precision and withoutany
complications.We have now established the technique offetal endoscopy,and are quite confidentto embark
upon fetal surgeryby this route.
Technical advances continue to expand the number of genetic disorders thatcan be diagnosed and even treated
in utero. The currentmethods for prenatal diagnosis are ultrasound,amniocentesis,fetal blood sampling,biopsy
of fetal skin,and chorionic villus sampling (CVS).Fetoscopy had been developed which permitted the
perinatologistto enter the uterus and obtain tissue sample or to actually view the fetus in the early 1980s [7]. In a
few experienced centers in the world, fetoscopyhas consolidated its position in fetal medicine,because ofa
combination ofinsightinto the pathophysiologyof selected conditions thatare amenable to fetal surgeryand the
technical innovations in endoscopic equipment.The first clinical fetoscopywere interventions on the umbilical
cord and the placenta.In clinical practice, surgical interventions on the placenta,umbilical cord and fetal
membranes,laser coagulation ofplacental vessels in cases offeto-fetal transfusion syndrome,and cord
occlusion in monochorionic pregnancies are the mostcommon procedures.Also,for some fetal conditions
requiring in utero surgery wherein mostexperience has been gathered with congenital diaphragmatic hernia.
Future developments offetal endoscopic operations should involve concepts to reduce maternal invasiveness
and complications,eventuallyimproving acceptance by parents and doctors [8].
Interestin fetal intervention has become widespread in recentyears.Laser therapy for the treatment of severe
twin–twin transfusion alone has been the subjectofmore than 100 peer-reviewed articles in the last3 years. The
outcome of a randomized clinical trial demonstrating thatfetoscopic laser coagulation ofchorionic plate vessels is
the mosteffective treatmentfor twin–twin transfusion syndrome (TTTS) has revived interestin endoscopic fetal
therapy [9]. Operating on the fetus is another more challenging enterprise.Clinical fetal surgeryprograms were
virtually non-existentin Europe until minimallyinvasive fetoscopic surgerymade such operations clinically
possible as well as maternallyacceptable.At present,mostexperience has been gathered with fetal tracheal
occlusion as a therapy for severe congenital diaphragmatic hernia.As in other fields,minimallyinvasive surgery
has pushed back boundaries and now allows safe operations to be performed on the fetal patient.
While minimal access seems to solve the problem ofpreterm labor,all procedures remain invasive,and carry a
risk to the mother and a substantial risk ofpreterm prelabor rupture ofthe membranes (PPROM). The latter
problem mayprove to be a bottleneck for further developments,although treatmentmodalities are currentlybeing
evaluated [10]. Reviews of current clinical status and recentadvances in endoscopic and open surgical
interventions show thatin mostcenters,fetoscopic interventions are widelyembraced,compared to open fetal
2. surgery. In terms of surgeryon the fetus, an increasinglyfrequentindication is severe congenital diaphragmatic
hernia,as well as myelomeningocele.The efficacy of intrauterine fetal therapeutic intervention is still to be
determined as treatmentofcongenital diaphragmatic hernia,cardiac defects,lower urinarytract obstruction,and
sacrococcygeal teratoma.
Fetoscopy has been found to lower the incidence of preterm labor compared to open surgeryand very effective
for treating several fetal anomalies [11].Maternal safety is the mostcrucial.A case of postoperative pulmonary
edema in a mother who underwentminimallyinvasive fetal surgery for the treatmentof twin reverse arterial
perfusion sequence has been reported.Probably,pulmonaryedema resulted from saline irrigating fluid (totaling
net 8 L) used during the procedure to facilitate surgical exposure,absorbed intravenouslythrough myometrial
venous channels accessed by passage ofthe operating trocars [12]. Overall maternal safety is high,but rupture
of the membranes and preterm deliveryremain a problem.
The increasing application offetal surgery has triggered the interestto embark on fetal surgical therapy, although
the complexity as well as the overall rare indications is a limitation to sufficientexperience on an individual basis.
Significantissues have arisen thataffect the availabilityof these new therapies.Increased exchange between
high volume units and collaborative studies—with strictness for self-regulation—is advocated by world-renowned
pioneers [13].Formal training fellowships have yet to be established.The establishmentofresearch netwo rks to
evaluate new fetal therapies through randomized clinical trials appears paramountto the advancementof the
field [14]. The future of fetoscopic surgical intervention depends on the continued evolution of novel techniques,
the elucidation ofthe pathophysiologyand treatmentof fetal disorders,and a better understanding oftreatmentof
complications ofinterventions [15]. Currentand probable future applications offetoscopyare appreciated by this
route of fetal access in India.The registration of all experience for prospective data collection should be
encouraged,supported byFOGSI; with the primarytarget being the assessmentofmaternal safety and fetal
improvement.
Conclusions
Fetal endoscopy—“Fetoscopy” is a feasible,safe procedure in the hands ofexperts in fetal diagnostic and
therapeutic techniques.Fetoscopyhas been established atour center, and the process was an intense “learning
curve,” posing unique requirements,extreme care, precision,and technical expertise,with innovation and
refinement.Practice with the new equipmentand finer instruments,and proper orientation to the intrauterine
environmentwith ultrasound—fetoscopy—laser coordination was absolutelyessential,to become skilled in the
procedure before embarking on fetoscopic fetal surgeryin high-risk ongoing pregnancies,which we are now
ready for.
Authors: Deka D, Dadhwal V, Gajatheepan SB, Singh A, Sharma KA, Malhotra N.
Recommended By(co-author):
DR APRAJITA SINGH, MD,DNB,MNAMS
OBSTETRICS & GYNAECOLOGY
Consultant,Director & Founder
Aaditri MultispecialityClinic
R-274,Greater Kailash Part-1,New Delhi 110048 (INDIA)
aaditriclinic@gmail.com +91-11-65658647
Attending Consultant
Indraprastha Apollo Hospitals,New Delhi
https://in.linkedin.com/in/dr-aprajita-singh-md-dnb-mnams-86713749