Fetal Surgery in the Primate 4.0: A New Technique 30 Years Later

Erin E. Perrone, Laura A. Galganski, Alice F. Tarantal, Katie J. Olstad, Marjorie C. Treadwell, Deborah R. Berman, Marcus D. Jarboe, George B. Mychaliska, Diana L. Farmer

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Open fetal surgery requires a hemostatic hysterotomy that minimizes membrane separation. For over 30 years, the standard of care for hysterotomy in the gravid uterus has been the AutoSuture Premium Poly CS*-57 stapler. Objective: In this study, we sought to test the feasibility of hysterotomy in a rhesus monkey model with the Harmonic ACE®+7 Shears. Methods: A gravid rhesus monkey underwent midgestation hysterotomy at approximately 90 days of gestation (2nd trimester; term = 165 ± 10 days) using the Harmonic ACE®+7 Shears. A two-layer uterine closure was completed and the dam was monitored by ultrasound intermittently throughout the pregnancy. At 58 days after hysterotomy (near term), a final surgery was performed to evaluate the uterus and hysterotomy site. Results: A 3.5-cm hysterotomy was completed in 2 min 7 s. The opening was hemostatic and the membranes were sealed. Immediately after closure and throughout the pregnancy, ultrasound revealed intact membranes without separation and normal amniotic fluid levels. At term, the scar was well healed without signs of thinning or dehiscence. Conclusions: The Harmonic ACE®+7 Shears produced a hemostatic midgestation hysterotomy with membrane sealing in the rhesus monkey model. Importantly, healing was acceptable.

Original languageEnglish (US)
JournalFetal Diagnosis and Therapy
DOIs
StateAccepted/In press - 2020

Keywords

  • Fetal surgery
  • Harmonic ACE+7 Shears
  • Hysterotomy
  • Prenatal surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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