MEDICAL PIONEER ON RACE AGAINST TIME

The pioneering in-womb surgery is steered by a theatre team of up to 30 multi-disciplinary specialists.

The mother is first given an anaesthetic, which passes to the baby.

The surgical team have to carefully monitor the vital signs of the baby throughout the procedure to ensure it does not become distressed. Surgeons open the mother’s abdomen and uterus in a similar way to a caesarean section using an incision in the bikini line. The opening in the abdomen is slightly wider than the cut used for a caesarean, but is in the same place in the lower abdomen.

This is because it has to be big enough to allow the surgeons to safely lift the uterus, or womb, out of the mother. Surgeons ensure the foetus is face down so they can expose the correct part of the baby’s spine to operate on. This allows them to make an incision in the uterus and expose the spina bifida defect in the foetus. In the later stages of pregnancy the uterus is one of the most blood-heavy organs in the human body and surgeons have to take extreme care when cutting into it.

The neurosurgeon then cuts around the exposed spinal cord, which is protruding through a hole in the back of the foetus, to isolate the crucial nerve tissue. The spinal cord is separated from the surrounding skin and then put back into the spinal canal.

With the nerve endings protected inside the spinal canal, doctors have to close over the delicate membranes around the spinal cord which, on a tiny patient, is an incredibly complex task. This allows them to create a new protective tube around the spinal cord. The muscles and skin are then brought together and stitched closed. This protects the spinal cord and prevents leakage of further spinal fluid. Finally, the uterus and abdomen are securely closed and the mother and baby are taken back to the recovery area.

The baby remains in the mother’s womb until approximately 37 weeks, before being born by caesarean section. The procedure does not cure spina bifida but research shows it can reduce the severity of the disabilities often associated with the condition.