OP08.05: Vascular cannula‐assisted tracheal access to simplify fetal endoscopic tracheal occlusion

To assess the usefulness of a plastic vascular cannula for aiding in accessing into the trachea during fetal endoscopic tracheal occlusion (FETO). Retrospective cohort study of consecutive fetuses affected with congenital diaphragmatic hernia (CDH) undergoing FETO in a single fetal surgery centre in Mexico. A trocar-assisted technique to aid in tracheal access was used in a subgroup of fetuses. Briefly, once the fetoscope reached the epiglottis, the 10F plastic vascular introducer used to access the uterus, was pushed forward beyond the tip of the fetoscope and against the posterior wall of the pharynx. Subsequent mobilisation of the epiglottis was performed under direct fetoscopic vision from within the introducer, avoiding impact of the endoscope lens against the surrounding structures and allowing better visualisation of the vocal cords to facilitate the access into the fetal trachea. Feasibility and intrauterine fetoscopic time were compared between cases with and without introducer-assisted tracheal access. Nineteen CDH fetuses treated with FETO were compared with 21 cases where FETO was assisted by the vascular introducer. Endotracheal placement of the balloon was performed successfully in all cases. The GA at FETO was similar in both groups (30.0 vs. 29.3, p = 0.07). The FETO group assisted by the vascular canula required significantly shorter intrauterine surgical times (12.7 vs. 27.1 min, p < 0.01), shorter time until entrance into the trachea (2.99 vs. 6.94 min, p = 0.02), shorter time until detaching of the tracheal balloon (9.4 vs. 18.9 min, p < 0.05) and lower occurrence of long intrauterine surgical time (>30min) 36.8% vs. 9.5%, p < 0.05). In CDH fetuses, vascular cannula-assisted tracheal access reduces intrauterine fetoscopic time for tracheal occlusion.