Fetal surgery has made significant strides over the past 40 years, facilitated by advances in technology and imaging modalities enabling the diagnosis and treatment of a congenital anomaly in utero. The MOMS trial, a multicenter randomized controlled trial, established open fetal myelomeningocele repair as the gold standard for improving neurological outcomes compared to postnatal repair. However, this approach is associated with increased Maternal Fetoscopic Myelomeningocele Repair Complications and preterm birth due to hysterotomy, prompting the exploration of minimally invasive alternatives. Due to the lack of an existing randomized control trial with fetoscopic MMC repair and variations in technique (percutaneous versus laparotomy/transuterine access, different trocar configurations, closure methods, and patch applications) among different fetal centers, more studies are needed to optimize this approach as an alternative to the standard of care. Cruz et al. from the Nationwide Children's Hospital, Columbus, propose to assess the basic tenets of open fetal MMC repair and to establish guiding principles for a fetoscopic approach that could prove to be equivalent or superior to open fetal MMC repair in maternal and fetal outcomes and lead to clinical implementation 1).
Fetoscopic MMC repair is a promising alternative to traditional open fetal surgery, balancing maternal safety with improved fetal outcomes.