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Wataganara T, Trigo L, Lapa DA. Teaching and training the total percutaneous fetoscopic myelomeningocele repair. J Perinat Med 2021; 49:jpm-2020-0591. [PMID: 33818041 DOI: 10.1515/jpm-2020-0591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022]
Abstract
Skin-over-biocellulose for Antenatal Fetoscopic Repair (SAFER) is a recently developed technique for fully percutaneous fetoscopic repair of myelomeningocele. The formation of a neo-dura mater triggered by the use of a biocellulose patch over the placode obviates the need of primary repair of fetal dura mater, and seems to further improve neurodevelopmental outcome. Insufflation of humidified carbon dioxide into the amniotic cavity requires proper training and a different equipment set from those used in the classic "under-water" fetoscopy. To shorten the learning curve of novice teams, we have developed a structured training course encompassing three critical steps: (1) visiting the proctor center, (2) selection of the first case, and (3) on-site training of the surgical team. Upon the site arrival, there will be: (1) theoretical lecture for all specialists involved in the fetal care, (2) simulation training, and (3) surgical proctoring. Proctor team can take over the surgery if the local team cannot complete. This training course has been successfully used in five different countries: Israel, Chile, Italy, USA and England and all local teams are already performing surgeries solo without any failures or maternal morbidity. Teaching new procedures in fetal medicine is challenging, because of the small number of candidate cases, and the direct relation of good outcomes and the number of cases operated. This proposed training modules may be adopted by other teams that want to embark on this type of novel minimally invasive treatment.
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Affiliation(s)
- Tuangsit Wataganara
- Division of Maternal Fetal Medicine, Department of Obstetrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lucas Trigo
- Hospital Israelita Albert Einstein, Fetal Therapy Program, São Paulo, SP, Brazil
| | - Denise Araujo Lapa
- Hospital Israelita Albert Einstein, Fetal Therapy Program, São Paulo, SP, Brazil
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Windrim R, Young A, LeBouthillier F, Ryan G, Van Mieghem T, Abbasi N, Keunen J, D'Souza R, Kfouri J. A novel "video-game" simulator for training fetoscopic laser coagulation of anastomoses in twin-to-twin transfusion syndrome. Prenat Diagn 2021; 41:1589-1592. [PMID: 33694186 DOI: 10.1002/pd.5926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/31/2020] [Accepted: 02/10/2021] [Indexed: 01/02/2023]
Abstract
We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The use of simulation improves training of the fetoscopic laser techniques utilized in the treatment of twin-twin transfusion syndrome A number of mannequins have been developed to aid this education WHAT DOES THIS STUDY ADD?: Two new simulators are described for twin-twin transfusion syndrome training-silicone and digital The digital simulator is a novel digital video game virtual format This new format has enhanced interactivity and has the potential to enable distance learning.
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Affiliation(s)
- Rory Windrim
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Young
- Department of Biomedical Communications, Biomedical Communications Program, University of Toronto, Toronto, Ontario, Canada
| | - Francis LeBouthillier
- Faculty of Art, Ontario College of Art and Design University, Toronto, Ontario, Canada
| | - Greg Ryan
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nimrah Abbasi
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Johannes Keunen
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kfouri
- Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Biomedical Communications, Biomedical Communications Program, University of Toronto, Toronto, Ontario, Canada
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Wataganara T, Yapan P, Moungmaithong S, Sompagdee N, Phithakwatchara N, Limsiri P, Nawapun K, Rekhawasin T, Talungchit P. Additional benefits of three-dimensional ultrasound for prenatal assessment of twins. J Perinat Med 2020; 48:102-114. [PMID: 31961794 DOI: 10.1515/jpm-2019-0409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022]
Abstract
Three-dimensional ultrasound (3DUS) may provide additional information for prenatal assessment of twins. It may improve the diagnostic confidence of dating, nuchal translucency (NT) and chorionicity assignment in twin pregnancies. The "virtual 3DUS placentoscopy" can guide selective fetoscopic laser photocoagulation (SFLP) to treat twin-twin transfusion syndrome (TTTS). Volumetric assessment of the dysmorphic acardiac twin with the Virtual Organ Computer-aided Analysis (VOCAL) software is more accurate than the conventional ultrasound measurement. Twin anemia polycythemia (TAP) sequence and selective intrauterine growth restriction (sIUGR) may be clinically monitored with 3DUS placental volume (PV) and power Doppler vascular indices. Congenital anomalies are more common in twins. Evaluation of fetal anomalies with 3DUS could assist perinatal management. The 3DUS power Doppler can provide a better understanding of true and false umbilical cord knots, which are commonly found in monoamniotic (MA) twins. Single demise in monochorionic (MC) twin pregnancies can cause severe neurologic morbidity in the surviving co-twin. Prenatal prediction of brain injury in the surviving co-twin with unremarkable neurosonographic examination is difficult. The 3DUS power Doppler may aid in prenatal detection of subtle abnormal cerebral perfusion. Prenatal assessment of conjoined twins with 3DUS is important if emergency postnatal surgical separation is anticipated. There is no significant additional advantage in using real-time 3DUS to guide prenatal interventions. Assessment of the cervix and pelvic floor during twin pregnancies is enhanced with 3DUS. Due to lack of high-quality studies, routine prenatal 3DUS in twin pregnancies needs to be balanced with risks of excessive ultrasound exposure.
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Affiliation(s)
- Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Piengbulan Yapan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sakita Moungmaithong
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nalat Sompagdee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nisarat Phithakwatchara
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pattarawan Limsiri
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Katika Nawapun
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanapa Rekhawasin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pattarawalai Talungchit
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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