Robot-Assisted Endoscopic Intrauterine Myelomeningocele Repair: A Feasibility Study

Abstract

Background: Animal experiments have suggested that the intrauterine environment causes secondary injury to the congenitally dysplastic spinal cord. This in turn suggests that early closure of the myelomeningocele sac might prevent secondary injury and therefore improve neurologic outcome. This study was designed to examine the technical feasibility of performing intrauterine myelomeningocele repair using a robot-assisted endoscopic system in an animal model. Methods: Six fetal sheep underwent creation and repair of a full-thickness skin lesion using the da Vinci^TM system. Results: With the device’s advanced articulated instruments and three-dimensional optics, it was possible to endoscopically repair the induced skin defects. Conclusion: We conclude that, with the recent evolution in robotics and minimally invasive techniques, intrauterine endoscopic surgery has become a realistic goal that promises to reduce the associated risks of fetal surgery and extend the indications for its use.