**7. Future of fetal surgery**

Minimally invasive treatment is undoubtedly the future of fetal surgery, with the goal of providing the best possible outcome for the fetus, while minimizing the morbidity or mortality to the mother. So the concept of treating two patients at the same time is the challenging goal. To this end, significant efforts are being made toward safest methods for fetal intervention, particularly premature rupture of membranes. Currently a collaboration between University of California San Francisco, the University of California Berkeley, and Caltech is focusing on the development of a biocompatible adhesive (methyldihydroxyphenylalaninebased polymers) to preseal amniotic membranes before fetal surgery to prevent PPROM. This formula is currently under development and called "Amnioseal" which can be delivered just below the uterus to preseal the fetal membrane before amniotic access. At the moment, prenatal stem cell transplantation and gene therapy is under extensive research to treat a wide range of genetic conditions, and to extend the current application of fetal surgical intervention for only correction of structural fetal anomalies. The in utero stem cell transplantation will prevent the process of abnormal immune development before the fetus cellular differentiations. Two types of fetal stem cell therapy are currently under investigations for potential clinical use the in utero hematopoietic stem cell transplantation and mesenchymal stem cell transplantation. Many recent clinical trials of in utero hematopoietic stem cell transplantation reported that it has had a limited success in recipients without underlying immunodeficiency, however, some experimental data in a large animal model of intrauterine hematopoietic stem cell transplantation have demonstrated clinically relevant levels of chimerism, may be supporting its role for inherited hematologic disorders. On the other hand, the use of in utero human fetal mesenchymal stem cell transplantation has been reported for osteogenesis imperfect, although the preliminary results are promising, it temporally

**17**

**Author details**

Egypt

Ahmed Abdelghaffar Helal

provided the original work is properly cited.

\*Address all correspondence to: helalhmada@azhar.edu.eg

*Principles of Fetal Surgery*

tions in clinical practice.

*DOI: http://dx.doi.org/10.5772/intechopen.85883*

results. Finally, the studies of fetal gene therapy and gene-editing technology as a new treatment lines for fetal genetic disorders, are significantly advancing in the field of fetal therapy. However, the safety and long-term effect of these new types of treatment must be thoroughly evaluated in animal models before its applica-

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Pediatric Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo,

*Principles of Fetal Surgery DOI: http://dx.doi.org/10.5772/intechopen.85883*

*Pediatric Surgery, Flowcharts and Clinical Algorithms*

tion of a sclerosing agent can be successful.

surgery has been performed.

sive neonatal therapy required [79, 80].

**7. Future of fetal surgery**

• In microcystic lesions, cysts are too small for drainage. In these cases, open fetal

• When a systemic feeding vessel is found, percutaneous laser coagulation or injec-

Routine ultrasound used as screening method for detection of congenital lung lesions and require referral to a specialist center. Other co-existing problems of the fetus should be carefully evaluated to determine, the magnitude of related complications, delivery place, time and type, and if intra-uterine intervention is needed. Minimally invasive intra-uterine fetal intervention for severe lesions can greatly improve the prognosis of these fetuses. In a large study of thoraco-amniotic shunt placement for congenital lung mass or pleural effusion, performed on 75 fetuses at Children's Hospital of Philadelphia, they showed 55% decrease in congenital cystic adenomatoid malformation volume and 27% of cases showed complete drainage of pleural effusion (73% showed partial drainage of effusions) with hydrops resolution in 83% of fetuses (43/53), which was greatly correlated with survival. Survival to delivery was 93% (70/75), median gestational age was 36 weeks, with 68% (51/75) long-term survival rate. Fifty-six percent of fetuses were delivered at an average of 10 weeks after shunt placement. Duration of stay in the neonatal intensive care unit of 21 days, with for greater than 24 hours. This series affirms the survival benefit risk patients, but underscores the risks inherent to in utero inten-

Minimally invasive treatment is undoubtedly the future of fetal surgery, with the goal of providing the best possible outcome for the fetus, while minimizing the morbidity or mortality to the mother. So the concept of treating two patients at the same time is the challenging goal. To this end, significant efforts are being made toward safest methods for fetal intervention, particularly premature rupture of membranes. Currently a collaboration between University of California San Francisco, the University of California Berkeley, and Caltech is focusing on the development of a biocompatible adhesive (methyldihydroxyphenylalaninebased polymers) to preseal amniotic membranes before fetal surgery to prevent PPROM. This formula is currently under development and called "Amnioseal" which can be delivered just below the uterus to preseal the fetal membrane before amniotic access. At the moment, prenatal stem cell transplantation and gene therapy is under extensive research to treat a wide range of genetic conditions, and to extend the current application of fetal surgical intervention for only correction of structural fetal anomalies. The in utero stem cell transplantation will prevent the process of abnormal immune development before the fetus cellular differentiations. Two types of fetal stem cell therapy are currently under investigations for potential clinical use the in utero hematopoietic stem cell transplantation and mesenchymal stem cell transplantation. Many recent clinical trials of in utero hematopoietic stem cell transplantation reported that it has had a limited success in recipients without underlying immunodeficiency, however, some experimental data in a large animal model of intrauterine hematopoietic stem cell transplantation have demonstrated clinically relevant levels of chimerism, may be supporting its role for inherited hematologic disorders. On the other hand, the use of in utero human fetal mesenchymal stem cell transplantation has been reported for osteogenesis imperfect, although the preliminary results are promising, it temporally

**16**

results. Finally, the studies of fetal gene therapy and gene-editing technology as a new treatment lines for fetal genetic disorders, are significantly advancing in the field of fetal therapy. However, the safety and long-term effect of these new types of treatment must be thoroughly evaluated in animal models before its applications in clinical practice.
