Foetal Surgery Unit

The Congenital Defects Committee, a multi-disciplinary group that studies diagnosed cases of congenital alterations every week, constitutes the basis from which candidate patients for prenatal surgery are selected. After the prenatal council, it is decided which patients will receive treatment.

The Foetal Surgery Unit provides a surgical response for all prenatal pathologies currently susceptible to treatment and, more specifically, it is internationally renowned for the foetoscopic treatment of neural tube defects (spina bifida), for which they have described a pioneering technique (“Two Layers” technique), with interventions in over 50 cases.

The unit's objective is to appropriately advise families, offer the best minimally-invasive treatment and provide constant support for the two patients, mother and baby, during their therapeutic process, subsequently linked to continued care for the newborn baby by other highly-complex neonatal specialities. More specifically, for neural tube defects, the hospital campus has its Spina Bifida Department which supports patients from their prenatal diagnosis to the end of their days, coordinating the various professionals from different specialities whose assistance they will need throughout their lives.

One of the Foetal Surgery group’s distinguishing features is its research activity, with various lines open in cellular therapy, surgical technique, clinical development and teaching. In addition to a number of publications and projects, this unit is particularly active in the development of theory-practical courses on foetal surgery, and has developed various simulation models, including myelomeningocele foetoscopic surgery.

The group has developed a cross-cutting Spina Bifida Research Programme which brings together various research groups at the Vall d’Hebron Research Institute, with the aim of making advances in the diagnosis and treatment of these patients.

Portfolio of services in which the paediatric surgery team takes part

• Foetoscopic surgery for congenital diaphragmatic hernia (FETENDO)

• Foetoscopic surgery of the amniotic bridle

• Foetal surgery, open and foetoscopic, of open defects of the neural tube (mielomeningocele and myelocele)

• EXIT procedure (Ex Utero Intrapartum Treatment) for pathologies that may affect the airways of newborn babies (cervical tumours, lung masses, etc.)

• Endoscopic and open surgery of sacrococcygeal teratomas

• Surgery on lower urinary tract obstructions (LUTO)

• Open surgery on lung malformations

• Foetoscopic surgery on upper airway pathologies

Some related recent publications:

• Manrique S, Maíz N, García I, Pasqual M, Perera R, Arévalo S, Giné C, Molino JA, López M, Blanco D, de Nadal M, Carreras E. Maternal anaesthesia in open and fetoscopic surgery of foetal open spinal neural tube defects: A 6-year observational study. Eur J Anesthesiol Nov 30 2018, DOI: 10.1097/EJA.0000000000000930

• Giné C, Arévalo S, Maíz N, Rodó C, Manrique S, Poca A, Molino JA, Carreras E & López M. Fetoscopic two-layer closure of open neural tube defects. Ultrasound Obstet Gynecol 2018 Oct;52(4):452-457.

• Marotta M, Fernández-Martín A, Oria M, Fontecha CG, Giné C, Martínez-Ibáñez V, Carreras E, Belfort MA, Pelizzo G, Peiró JL. Isolation, characterization, and differentiation of multipotent neural progenitor cells from human cerebrospinal fluid in fetal cystic myelomeningocele. Stem Cell Res 2017 May 15;22:33-42

• Iliescas T, Rodó C, Arévalo S, Giné C, Peiró JL, Carreras E. The quantitative lung index and the prediction of survival in fetuses with congenital diaphragmatic hernia. Eur J Obstet Gynecol Reprod Biol 2016 Jan 11;198:145-148

• Rodó C, Illescas T, Arévalo S, Pérez-Hoyos S, Carreras E. Follow-up of fetuses with congenital diaphragmatic hernia: The quantitative lung index. Eur J Obstet Gynecol Reprod Biol. 2018 Jun;225:22-25. doi: 10.1016/j.ejogrb.2018.03.036. Epub  2018 Mar 26. PubMed PMID: 29627662