Sophisticated Tools Lead to Breakthroughs in Prenatal Surgery

Many breakthroughs in prenatal surgery have only been possible because of ever more sophisticated instruments. Since 2011, Michael Belfort, the chief obstetrician at Texas Children’s Hospital in Houston, has been enhancing the tools he uses to operate on a developing fetus. His modified instruments have led to fewer preterm deliveries and C-sections for mothers, and his surgeries have helped improve survival rates for infants. He can insert optical fibers that let surgeons see inside the uterus. He can also tug delicate fetal skin and guide suture needles using a grasper. And he can work wonders that only a few decades ago would have defied belief.

Called a Betocchi sheath, this hysteroscope is normally used for surgeries inside non-pregnant uteruses. Before using smaller scopes, Belfort’s team repurposed this one for fetal surgeries—its dual channels are useful for inserting a fiber-optic camera and an operating instrument through the same incision.

In order to arrive at this first iteration of his modified fetoscopes, Belfort had to find a jewelry manufacturer who works with FDA-approved lasers to cut and re-weld the factory scope.

Half as short as their predecessor, these second-gen modded scopes are short enough for the surgeons to hold one-handed, without an assistant’s help. Through one, Belfort provides vision with a fiber-optic camera and assists an accompanying neurosurgeon with forceps.

Operating the other scope in the pair is a neurosurgeon who's charge of making incisions into fetal skin and stitching it up afterwards.

During surgeries for spina bifida—a birth defect in which the spine forms incorrectly—Belfort uses these forceps to pull back fetal tissue for a neurosurgeon to make incisions that release the spinal cord into its correct position.

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