This glowing red sphere is a mother’s womb OUTSIDE her body as surgeons perform a pioneering operation on her 24-week-old baby that could transform countless lives...
The TheATRe lights are dimmed and the heating has been boosted to sauna levels when suddenly an eerie red glow illuminates the hands and faces of the doctors who crowd around the operating table.
Its source is a medical marvel — a human womb as we have never seen it before, raised up from a woman’s body so that surgeons can perform life-changing spinal surgery on the baby boy inside.
he is just 24 weeks and two days old and weighs less than 2lb.
The glow comes from a tiny light on the camera that has been inserted via a 4mm slit into the womb of Lexi Royer. It will relay images to the three enormous flat-screen TVs in the operating theatre, allowing surgeons to safely manipulate the precision instruments through a second tiny slit in the womb.
The ground-breaking operation on a 28-year-old California hairdresser was performed on September 27 by U.S. doctors who are pioneering the procedure — known as fetoscopic repair — to treat a severe form of spinal defect without cutting open the womb.
A routine ultrasound scan in May had shown that the foetus had spina bifida, an abnormality of the neural tube that will develop into the spinal cord and brain.
Part of the tube does not form properly or there is incomplete closing of the membrane and bones, leaving the spinal cord exposed. It affects 24 babies in 100,000 and has been associated with B-vitamin folic acid deficiency.
As pregnancy progresses, the amniotic fluid surrounding the foetus becomes increasingly toxic to the delicate nervous tissue as foetal waste material accumulates, worsening the condition and its consequences.
It is generally too late to operate after birth and children with spina bifida are often unable to walk, may need catheters to pass urine and are at risk from brain damage because of a fluid-build up in the brain which may need a shunt implanted under the skin of the skull to drain it.
Since the 1990s, ‘open surgery’ on babies with spina bifida has been performed with mixed success. It requires a 6cm incision made into the womb to access the child. however, the procedure has been linked to premature births and other harmful side-effects — such as poor healing of the uterine scar — for mothers who must give birth by Caesarean section in case of womb rupture during labour.
Now an amazing alternative has been developed by Dr Michael Belfort, chief obstetrician and gynaecologist at Texas Children’s hospital in houston, and his colleague, Dr william whitehead, a paediatric neurosurgeon, allowing them to briefly remove the womb — intact and still attached to the mother via muscle, blood vessels and connective tissue — and perform surgery through tiny incisions in its side.
The procedure took three years to develop in collaboration with doctors in Barcelona.
The two American surgeons perfected their technique by practising with a rubber football — replicating the womb — which contained a doll covered in chicken skin, which acted as the baby.
Dr Belfort and his colleagues have now performed 28 such operations at between 24-26 weeks of pregnancy — with no deaths — since 2014, as reported in the journal obstetrics & Gynaecology. But news of the breakthrough emerged only this week.
Former high school sweethearts Lexi Royer and her husband Josh, a 29-year-old fireman, from San Diego, California, had long been trying for children but had suffered a miscarriage and no further pregnancies.
early this year, they were overjoyed to learn that they had conceived. But a scan at 13 weeks confirmed the foetus had spina bifida, which typically develops at just three to four weeks of pregnancy when the neural tube should be closing.
In this case, the defect was particularly severe and doctors suggested Lexi have an abortion.
‘It sounded like we were looking at brain damage, feeding tubes, a breathing tube, a wheelchair . . . just a bad quality of life,’ she said this week.
But acutely aware this might be their only chance of having a child, the Royers searched the internet and found reports of Dr Belfort’s work.
Two days of tests in houston followed — and suddenly they had hope. The child Lexi was carrying was able to kick his legs and flex his ankles: a sign that he might be able to walk damage to his spinal cord from the amniotic fluid could be halted.
on the day before the operation, the Royers met the dozen-strong medical team and Dr Belfort confirmed the baby had a ‘significant lesion’ involving much of his lower back, but ‘there’s a lot of function to save’.
ADDReSSInG Mrs Royer, he said: ‘This is experimental surgery, with no guarantee. You are the person who will take the risk for another person. There is no mandate for you to do this. nobody will think less of you if change your mind, and you can change your mind until the last minute, until you go to sleep.’
Lexi Royer didn’t change her mind. with country and western music playing in the background — at Mrs Royer’s request, although she was under anaesthetic by then — Dr Belfort began the operation, with ten doctors in the theatre and numerous specialist nurses on hand, sweating in temperatures raised to keep the baby’s heartbeat up. every few minutes, the paedriatic cardiologist called out the heart rate — which held steady at 150 beats per minute.
once the womb was removed and held steady by two doctors just
above the cavity, the amniotic fluid was drained from it and carbon dioxide pumped in to keep it expanded and enable the surgeons to move inside it more easily.
An anaesthetic injection was then administered to the baby, although it is not known if, or how much, it would feel pain. Guided by the images showing up on the monitors around them, and working with infinite care, the surgeons made a series of tiny snips in the skin along both sides of the baby’s body to loosen it so it could be tugged up and over to cover the exposed spinal cord.
The skin flaps were then sewn up with five minuscule stitches to ensure that amniotic fluid, regenerated as the pregnancy continued, didn’t leak in.
Finally, after almost three hours, saline solution containing an antibiotic was pumped into the womb before it was gently replaced inside Lexi’s abdomen and her wound sewn up.
Lexi and Josh’s son is due in January and, for now, they remain living in Houston, close to the hospital. They know that surgery hasn’t cured their baby and Dr Belfort says he will almost certainly suffer from some degree of disability.
A premature birth — brought on by the surgery — remains a risk.
Dr Belfort and his team admit they will only truly know how successful they have been when the Royers’ baby is delivered and they can assess the spina bifida repair and any physical defects.
However, they are predicting ‘a new era of foetal medicine and surgery’ thanks to ‘everadvancing technology’.
Some of the mothers operated on have been able to give birth naturally following the operation, which is seen as a major advance, being safer for mother and child with fewer complications than a Caesarean.
Some critics of the procedure warn that pumping the womb with carbon dioxide during the operation could itself cause neurological damage to the baby.
British experts caution that while the number of procedures carried out by the Texas team remains relatively small and so inconclusive, such surgery won’t yet be available in the UK — where there are some 14,000 people with spina bifida — for some years.
However, at least one couple, who had little hope of having a child without distressing disability and poor quality of life, see a brighter future now.
‘It’s not done [yet] by any means, but I definitely feel it’s the right thing for us,’ says mrs Royer. ‘Seeing the ultrasound and how good he’s doing, moving his ankles and feet, it’s such a happy moment.’