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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
With Dr. Beth Rymeski · hosted by Dr. Jill Knepprath
Chapter 1 of 6 · Fundamentals
FETO overview
Introduction and FETO Overview
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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
FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus.
A standard fetoscope with a side channel is used, and the balloon is worked through the side channel.
The tongue is an easy landmark to identify during FETO because it is bumpy in appearance.
Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.
If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.
The epiglottis is a key landmark to locate when navigating to the trachea.
Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.
The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.
The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.
The scope is backed up as the balloon is inflated so that balloon inflation can be watched.
The balloon contains a little metal ball that can be visualized.
The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea.
Sometimes the trocar advances into the mouth during the procedure and needs to be backed out.
Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea.