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Background: Premature rupture of membranes (PROM) remains a significant complication of fetal surgery. Rates of 40% to 100% have been reported after both open and endoscopic fetal surgery. We describe a technique of endoscopic port insertion and removal that minimizes trauma to the membranes. Methods: Twenty- seven consecutive patients undergoing endoscopic laser ablation for twin- to- twin transfusion syndrome were reviewed. In each case, a mini laparotomy was performed, and the amniotic cavity was entered under direct vision of the uterus using a Seldinger technique. The entry site was carefully dilated to accommodate a 4.0- mm- diameter cannula. A gelatin sponge plug was placed at port removal. Postoperative management and outcome were evaluated. Results: Median gestational age at operation was 21.3 weeks. Median operating time was 60 minutes. One patient delivered intraoperatively because of fetal distress. Seventeen (65.4% ) patients required postoperative tocolysis (median duration, 12 hours). Median postoperative gestation was 6.5 weeks (range, 1- 20 weeks). Only 1 (4.2% ) of 24 patients with successful gelatin sponge placement developed PROM. Conclusions: Meticulous technique and atraumatic insertion and removal of ports help minimize the risk of postoperative amniotic leak after endoscopic fetal surgery. Our PROM rate of 4.2% contrasts sharply with previously reported rates after similar operations.
We have a reported end both port and endoscopic fetal surgery. We describe a technique of endoscopic port insertion and removal that minimizes trauma to the membranes. Methods: Twenty-seven consecutive patients undergoing endoscopic laser ablation for twin-to-twin transfusion syndrome were reviewed. In each case, a mini laparotomy was performed, and the amniotic cavity was entered under direct vision of the uterus using a Seldinger technique . Median operating time was 60. Results: Median gestational age at operation was 21.3 weeks. The entry site was carefully dilated to accommodate a 4.0- mm- diameter cannula. A gelatin sponge plug was placed at port removal. One patient delivered intraoperatively because of fetal distress. Seventeen (65.4%) patients required postoperative tocolysis (median durati Only 1 (4.2%) of 24 patients with successful gelatin sponge placement developed PROM. Conclusions: Meticulous technique and atraumatic insertion and removal of ports help (on, 12 hours). Median postoperative gestation was 6.5 weeks minimize the risk of postoperative amniotic leak after endoscopic fetal surgery. Our PROM rate of 4.2% contrasts sharply with previously reported rates after similar operations.