Fetal surgery

…material is not lacking – particularly in this vast field of Medicine – in which to prove one's ability, that is, by perfecting things which have been left incomplete and untouched by the ancients or others and by making new contributions to knowledge…. Gaspare Tagliacozzi (1547–1599) De curtorum chirurgia per insitionem (c 1597) A. Read (trans.) London: Jones, 1867. Most disorders identified in the fetus are best managed in the early postnatal period. Over the last 25 years, however, fetal surgery has emerged from the realm of medical curiosity into an exciting, multidisciplinary specialty now capable of improving patient outcomes for a wide variety of diseases. Recent technologic progress now allows clinicians to both diagnosis and treat many fetal anomalies accurately while maintaining a high level of maternal safety. As expectant parents become increasingly educated about the potential benefits of fetal surgery, obstetricians must become familiar with some of the more recent, state-of-the-art advances that are currently shaping the field. The purpose of this chapter is to provide an overview of the principles of modern operative fetal intervention. To this end, the authors outline the basic ethical and diagnostic issues pertinent to the practice of fetal surgery and describe the major operative approaches to gain access to the fetus. The discussion then turns to some of the established as well as experimental prenatal therapies that are currently being employed for several lethal and nonlethal anomalies (Table 20.1).