In utero surgery - current state of the art: Part I

Background: Fetal surgery, also referred to as in utero, prenatal or intrauterine surgery, consists of treatment of congenital malformations during fetal period. The idea of treating malformations diagnosed in the course of intrauterine life dates back to 1963, when Lilly performed first blood transfusion in the fetus. Ever since then, it has been introduced as treatment option in series of lethal malformations. Efforts are being made to treat nonlethal malformations by means of fetal surgery. Material/Methods: A comprehensive search of the literature using MEDLINE and PubMed between 1925 and February 2009 was performed. Search terms for MEDLINE and PubMed were: fetal surgery, foetal surgery, in utero surgery, prenatal surgery, and in utero treatment. In addition, information was obtained at Web sites of International Medicine and Surgery Society and the University of California Fetal Treatment Centre. Results: Our attention focused on the overall view on fetal surgery history, its development and perspectives. Moreover, owing to the authors' interest in plastic surgery, some remarks on the role of intrauterine medicine and surgery in this branch of medicine were made. Conclusions: In utero surgery may be regarded as an efficient tool of preventive medicine. It offers some advantages that no other branch of medicine may offer. However, its implementation is more troublesome than it used to be regarded as before. Therefore only selected cases may benefit from its advantages. Nevertheless, current tendencies are to include, after thorough evaluation of benefit - risk ratio, some new indications for fetal surgery.