Fetal surgery

New techniques have given surgeons a second chance

Operating on the fetus became technically feasible over 10 years ago,1 but it has remained semiexperimental; fetal surgery is attempted for strictly selected indications in a handful of centres worldwide. The slow progress of fetal surgery in the past decade and its poor survival record (19% for diaphragmatic hernia repair2) have led to assertions that it is a blind alley.

Yet many of the obstacles to success have been overcome. The technical aspects of operating on such fragile patients have been refined—paralleling the progress in postnatal surgery on very small and very premature infants. Postoperative uterine contractions, the most feared hazard of fetal surgery, can be better controlled by safe and effective drugs. Selection of patients has improved to reduce the …