Chirurgische verschlussmethoden von fetoskopisch erzeugten membrandefekten am mittelträchtigen kaninchenmodell

Purpose: In the pregnant rabbit model we compared surgical techniques to close defects of the fetal membranes caused by fetoscopy. Methods: Fetoscopy was performed in pregnant rabbits at 22 days' gestation (term, 32 days). The fetoscopic access sites were covered with human amniotic membrane and sealed with fibrin (group 1, n = 9); covered with collagen foil and sealed with fibrin (group 2, n = 9); or filled with a collagen plug and sealed with fibrin (group 3, n = 9). The myometium was closed with 6 - 0 nylon suture in all groups. In group 4 the membrane defect was not closed (positive controls). Untreated fetal sacs (n = 49) served as negative controls. Membrane integrity, presence of amniotic fluid, and fetal lung/body weight ratios were assessed at 29 days' gestation. The closure sites in groups 1-3 were studied histologically. Results: Results regarding membrane integrity, preservation of amniotic fluid, and fetal lung and body weight were best in group 3. Histology showed no entrapment of the membranes in the myometrial defect in any case with amnion integrity, thus demonstrating both functional and anatomic repair of the fetal membranes. Conclusion: Use of a collagen plug, fibrin sealant, and myometrial suture appears promising for closing fetoscopic access sites in the rabbit model.