A study on a minimally invasive fetal surgery for diaphragmatic hernia

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(1) Development of endoscopes for fetal surgeryTwo types of endoscope were developed ; one was for fetal observation and the other for fetal endotracheal occlusion. The outside diameter was 2.4 mm and 3.0 mm respectively.(2) Development of a balloon catheter for fetal endotracheal occlusionA balloon (1.2 mm in outside diameter, 5 mm in length and 0.1-0.15 mm in thickness) was made and connected with a silicon tube (0.7 mm in outside diameter and 0.3 mm in inside diameter).(3) Fetal endotracheal occlusion with a balloon catheter in sheepA cesarean section was performed in pregnant sheep under halothane anesthesia. A small incision was made on the uterine wall and the tip of an endoscope was inserted into the amniotic fluid through the incision. Lactated Ringer's solution was infused into the amniotic cavity for a wider field of vision. An endoscope for fetal observation was used to guide the tip of the other endoscope to the fetal nostril. However, the procedure of endoscopical guidance was abandoned because of difficulty. Thereupon, the fetal nostril was kept hold of by the operator's hands underneath the incision of the uterine wall and the tip of endoscope was inserted into the nostril. The tip was advanced beyond the epiglottis to the vocal cord and a balloon catheter was successfully placed in the trachea through the working channel of the endoscope.