| Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans. | |
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MedLine Citation:
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PMID: 19565298 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The technical performance of minimally invasive fetoscopic surgery may be severely hindered by poor visualization of intra-amniotic contents. Partial amniotic carbon dioxide insufflation (PACI) allows the visual limitations of operating within the fluid environment to be overcome. PATIENTS AND METHODS: When amniotic fluid exchange failed to improve fetoscopic visualization, PACI was attempted during 37 fetoscopic procedures between 17 + 5 and 33 + 2 weeks of gestation. PACI was attempted with filtered carbon dioxide using a commercially available insufflator via one to three trocars that were percutaneously introduced into the amniotic cavity. The maximum pressure during PACI was limited by the maximum insufflation pressure (30 mmHg) generated by the insufflator. Improvement of fetoscopic visualization as well as technical, maternal, and fetal safety aspects surrounding PACI were analyzed. RESULTS: PACI could successfully be instituted in 36 of the 37 procedures. In one case, when in the presence of increased uterine tone the opening pressure exceeded the maximum insufflation pressure of the insufflator, the strategy was abandoned. In all cases where PACI could be instituted successfully, the approach offered far superior visualization of the fetoscopic procedure than would have been possible within amniotic fluid. Acute or chronic maternal or fetal complications were observed in only one case (intraoperative membrane rupture). CONCLUSION: PACI greatly improves fetal visualization during fetoscopic interventions when fetoscopy within fluid meets with difficulties. Continued assessment of its benefits, risks, and safety margins at specialist centers is required. |
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Authors:
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Thomas Kohl; Kristina Tchatcheva; Julia Weinbach; Rudolf Hering; Peter Kozlowski; Rüdiger Stressig; Ulrich Gembruch |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-06-30 |
Journal Detail:
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Title: Surgical endoscopy Volume: 24 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-02-01 Completed Date: 2010-04-22 Revised Date: 2010-09-29 |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 432-44 Citation Subset: IM |
Affiliation:
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German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)-Department of Obstetrics & Prenatal Medicine, University of Bonn Medical School, Bonn, Germany. thomas.kohl@ukb.uni-bonn.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Amnion / injuries Amniotic Fluid* Carbon Dioxide / administration & dosage* Diseases in Twins / surgery Female Fetal Death / etiology Fetal Diseases / surgery Fetofetal Transfusion / embryology, surgery Fetoscopy / methods* Humans Hypotension / drug therapy Insufflation Norepinephrine / adverse effects, therapeutic use Postoperative Complications / etiology Pregnancy Pregnancy Complications / etiology Pregnancy Complications, Cardiovascular / drug therapy Pregnancy Outcome Spinal Dysraphism / embryology, surgery Young Adult |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 51-41-2/Norepinephrine |
| Comments/Corrections | |
Comment In:
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Surg Endosc. 2010 Oct;24(10):2640-1; author reply 2642-3
[PMID:
20354883
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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