Vall d’Hebron performs its first endoscopic surgery on a foetus with spina bifida using a pioneering technique

Spina bifida is a severe congenital malformation that causes musculoskeletal abnormalities and often leads to neurological problems and other complications. The standard treatment to correct this malformation was open foetal surgery, a highly complex procedure. It was necessary to open the mother’s uterus halfway through the pregnancy, as in a caesarean section, expose the foetus’s back to operate and surgically correct the defect, and then close the uterus again.

By contrast, fetoscopy, which is the technique used at Vall d’Hebron in 2014, involves accessing the mother’s uterus through two small incisions (without the need to open it) to reach the lumbar area of the foetus and operate on the malformation. The defect area is then closed with a bioadhesive patch that protects the spinal cord from contact with the amniotic fluid. As the foetus grows, the skin gradually replaces the adhesive and covers the patch so that by the time the baby is born, the defect is covered by skin. This innovative technique to seal the foetal defect was designed and developed by the Bioengineering, Orthopaedics and Paediatric Surgery Group at the Vall d’Hebron Research Institute (VHIR) after years of experimental surgery on animal models.

At that time, only two centres in the world, Germany and the United States, were performing these foetal interventions, and Vall d’Hebron was the only one to apply the bioadhesive patch.