In Utero Surgery: Doctors Repair Spina Bifida on Fetus While It’s Still in the Womb

The Cleveland Clinic is breaking new ground, performing the first in utero surgery in northern Ohio. Operating on a fetus inside the uterus is generally considered a risky procedure, but Dr. Darrell Cass, Director of Fetal Surgery in the Cleveland Clinic’s Fetal Center, and more than a dozen other specialists, are pushing the procedure to new heights. Cass and his colleagues used in utero surgery to repair spina bifida on a 23-week-old fetus. Find out how this ground-breaking procedure is changing prenatal care for the better.

What Is In Utero Surgery?

In utero, or fetal, surgery is performed on a fetus when it’s still in the uterus. It’s used to treat or reduce possible birth defects in the unborn child, giving them a better quality of life. Treating birth defects while the fetus is still in the womb is often more effective than operating on the child once it’s been born. It can be used to treat a range of birth defects, many of which can be life-threatening, including:

• Amniotic band syndrome
• Bronchopulmonary sequestration of the lung
• Congenital high airway obstruction syndrome (CHAOS)
• Fetal anemia
• Spina bifida (myelomeningocele)
• And many others

Performing in utero surgery presents risks for both the mother and her unborn child. The risks include the possible rupture of the uterus after surgery, the death of the fetus, operative complications, early labor, and the potential failure to treat the birth defect.

These birth defects are not always treatable, as is the case with spina bifida. In utero surgery may only be used to lessen these birth defects, so the child will be significantly less disabled as they go through life compared to the life they would have had if the surgery were performed after birth.

However, the medical community has made great strides with this type of procedure, which became clinically accepted in 2011. At that time, there were only four fetal surgery centers in the world, and Dr. Cass oversaw one of them. Today, fetal surgery is performed at around 20 healthcare facilities across North America, and the Cleveland Clinic can now count itself as one of them.

A Successful Operation

Dr. Cass led an all-star team, including pediatric neurosurgeons, a fetal cardiologist, and pediatric anesthesiologists, to perform surgery on the 23-week-old fetus with spina bifida, which means part of the tube that’s supposed to protect the lowest part of the spine cannot close, leaving the spinal cord exposed. The condition can cause significant disabilities later in life, including paralysis of the legs, difficulty urinating, and a build-up of pressure that can lead to brain damage.

Dr. Cass has performed over 160 successful fetal surgeries over the course of his career. He helped the Cleveland Clinic prepare for the procedure far in advance. As he told Fox 8 News in Cleveland, “We started doing simulations and walk-throughs and preparations for how the operations would go and how the family’s experience would be.” His team prepared for the operation for over a year, visiting top specialists in the field from around the country.

The clinic recorded a video to document the procedure for learning purposes. As Dr. Cass describes, “We open the uterus in the smallest way directly over where the baby’s back is positioned.” The team used ultrasound to monitor the baby’s position throughout the surgery.

By the end, Dr. Cass and his team were able to repair the baby’s spinal cord. They covered the tube with muscle and skin, which is referred to as a myofascial repair. Doctors were concerned the procedure may result in premature birth, but that wasn’t the case. The mother carried the baby nearly to term. She gave birth via c-section after 36.5 weeks, so the baby’s brain had more time to develop.

“The operation went perfectly, and in fact, the repair on this baby’s back is the best that I’ve seen in the last 20 years,” Cass said in an official statement. “She will still have to deal with some disability, and we are going to work on all of those things, but she will be as good as she can be.”

Here at Scrubs Mag, we’re hoping the best for the mother and her newborn baby.