Laser Ablation Now Being Used for Cutting-Edge Fetal Surgeries at the SSM Health St. Louis Fetal Care Institute

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With an incision the size of a pencil tip, the team at the SSM Health St. Louis Fetal Care Institute can now save the life of a baby before it is even born.

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"The advancement of minimally invasive fetal surgery such as laser ablation is changing the face of fetal medicine." Mike Vlastos, MD, director of the St. Louis Fetal Care Institute

Using cutting-edge techniques, the team of fetal surgeons at the Fetal Care Institute now utilizes laser ablation to stop blood-flow to life-threatening tumors, break through urinary tract blockages and more on babies while they are still in the womb.

The Fetal Care Institute is one of the few centers in the United States that can provide these minimally invasive, cutting-edge and potentially life-saving procedures for conditions such as bladder outlet obstruction, amniotic band syndrome and twin-to-twin transfusion syndrome. The team is also using the technology to develop new treatments for fetal lung masses and other fetal medical conditions.

"The advancement of minimally invasive fetal surgery such as laser ablation is changing the face of fetal medicine. We are seeing some babies who would have otherwise passed away in the womb given the chance to thrive, and in many cases live normal lives," says Fetal Care Institute Director and SLUCare Maternal Fetal Medicine Specialist Dr. Mike Vlastos, MD.

Laser ablation is the process of removing material from a solid (or occasionally liquid) surface by irradiating it with a laser beam. When it is used in fetal surgery, the surgeon makes a pencil-tip-sized incision and inserts a small scope called a fetoscope into the uterus. Using ultrasound guidance, a small needle is inserted into the area needing ablation, and a laser is fired, stopping the blood flow, or opening the blockage.

While laser ablation surgery has been used for quite some time for twin-to-twin transfusion syndrome (TTTS), the Fetal Care Institute is the only facility in the country that performs this procedure on bronchopulmonary sequestrations (BPS).

A BPS is a piece of lung tissue that develops without being connected to the airways, sometimes inside the lung and sometimes outside of it. When the needle is inserted into the BPS, a laser fiber is targeted at the abnormal blood vessel going to the BPS. The laser blocks the blood flow, causing it to stop growing. The goal of the operation is to reverse the process by which the BPS is causing heart failure in the fetus. After the surgery, the BPS takes less blood flow from the fetus, and the heart and lungs start growing more normally as the BPS shrinks in size

Fetoscopic surgery is much less invasive than open fetal surgery, thus decreasing the risk of pre-term labor. Mothers are given anesthesia during the procedure to help with pain control and anxiety. Babies are also given medication to decrease movement and prevent pain.

The Fetal Care Institute team performs fetal laser ablation surgeries at SSM Health St. Mary’s Hospital. Mothers typically remain in the hospital for one night for monitoring, then remain on modified bed rest for the rest of the pregnancy to decrease the risk of preterm delivery. Medications are also used for the remainder of the pregnancy to help decrease the chances of any preterm labor. Many mothers can carry the pregnancy to term, but some deliver their babies early, depending on the baby’s condition.

Because the uterine incision for fetoscopic surgery is very small mothers can go in to spontaneous labor in the current and future pregnancies, and can plan on vaginal deliveries. Based on current research, laser ablation surgery does not affect future pregnancies.

About the SSM Health St. Louis Fetal Care Institute
The SSM Health St. Louis Fetal Care Institute (Fetal Care Institute) is a partnership between SSM Health Cardinal Glennon Children’s Hospital, SSM Health St. Mary’s Hospital, and Saint Louis University School of Medicine. Bringing together renowned maternal fetal medicine (MFM) specialists, pediatric and fetal surgeons, specialized nurses, cutting-edge technology, and a family-oriented approach, the Fetal Care Institute offers state-of-the-art diagnostic methods and treatment options for families whose unborn babies are facing medical challenges. It is one of the nation’s leading comprehensive fetal care programs, offering a variety of fetal interventions and treatments, including open and minimally invasive fetal surgery for babies in the womb.

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Denise Nazzaro
since: 08/2010
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St. Louis Fetal Care Institute
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