Mauro H. Schenone, M.D. , describes fetal surgery, why it is necessary and the common conditions treated with surgery. Mark D. Rollins, M.D., Ph.D. , and Ellen M. Bendel-Stenzel, M.D. , highlight the skilled and collaborative team at Mayo Clinic and how the multidisciplinary team approach produces better patient outcomes.
The inspiration for my work are my patients. Some of them have a treatment option, but then we also keep fighting for those babies that currently don't have a therapeutic option. We envision a future where those babies will have an option. The more common um situations we encounter, uh, that require fetal surgery are um spina bifida and twin twin transfusion syndrome. What sets Mayo Clinic apart. Are number one, the outcomes. The benefit of treating myelomeningocele in utero is that it doubles the chances of a baby walking without orthotics or devices by 30 months of age. We have an 86%. Of reversal of hindbrain herniation, a 6% rate of delivery before 30 weeks of gestation, only a 5% risk of rupture of membranes prematurely. Then we have seen no cases of membrane separation during the last 4 years. When it comes to twin twin transfusion syndrome and laser therapy for those cases, our percentages are in the 80s for the survival of one twin. And 69% uh for survival of both twins. At Mayo Clinic, we benefit from a well established skill and structured team of fetal therapy. People that are highly engaged with our program, that care about our patients, and they're ready to help whenever the opportunity occurs. Mayo Clinic has a culture of safety and collaboration, and I think that is very unique to the institution. How paramount that is to these types of procedures. Part of the collaborative process with our maternal fetal medicine, anesthesia, surgical radiology, multiple subspecialists is that we meet on a regular basis at what we call fetal board. We start weeks in advance. As soon as we hear about the referral, communication goes out to a multidisciplinary team. Each one. of those teams begins to plan what needs to be done specifically for these patients, and we get a really nice multidisciplinary approach to these cases. That is what I think allows us to have the great outcomes that we do in this patient care conference. Everyone has an opportunity to voice concerns, to voice the potential benefits or risks. And at the end, we reach a consensus. Then we go back to the picture, have a conversation about what was the result of that meeting. And the patient ultimately makes that decision. We want the patient to be armed with the best information possible to make an informed decision. At Mayo Clinic, we count with cutting edge technology. We have a protocol that allows us to use the new generation Petoscopes. These scopes allow better visualization and better angle of approach in cases of 2 twin transfusion syndrome. For the most part, in most of our procedures, um, we're, we're talking about same day procedure or an overnight stay. Prematurity is the Achilles heel of fetal surgery and some of them need a prolonged admission to the NICU. When we care for any infant that underwent a fetal intervention, um, the care is very dependent upon what was done for each intervention that we do, we have different expectations for what we need to do uh in the delivery room and we just have to meet that expectation uh and prepare our parents for that. It fills us with tremendous joy. When patients, when we see this smile coming back at our parents uh after going through such a difficult time, and it keeps us stimulated to work hard and Provide the next patient with our, our, our best possible care.
