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Fetoscopic Endoluminal Tracheal Occlusion (FETO)
With Dr. Fung Lim · hosted by Dr. Rod Gerardo
Chapter 1 of 5 · Fundamentals
Introduction
Introduction to fetal surgery and congenital diaphragmatic hernia
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.
In mild diaphragmatic hernia, the left lung starts to shrink in size.
In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.
In the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking.
The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.
Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.
An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.
The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.
The ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi.
A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.
The balloon is left in place for a few weeks to accelerate lung growth.
If the baby is in proper position, the balloon can be punctured under ultrasound guidance.
The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.
If the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper.
After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.
Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.
Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus.
MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH.
Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO.
Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop.
The balloon is typically removed at about 34 weeks gestation.