"We believe the current philosophy of fetal

extraction and reinsertion for the treatment

of congenital cardiac conditions remains

flawed. Although preliminary, we believe

that robotic in-utero manipulation has

merit."

Dr. Michael D. Black, appointed Chief of

pediatric cardiac surgery at Stanford in

1999, was recently awarded the

Computerworld Honors in Medicine for his

unique surgical approach to advance the

art and science in the treatement of

congenital heart disease - 2002

Our initial experience with the repair of the most technically simple repairs such as, atrial septal

defects has enabled us to perform more complicated repairs. We currently apply; cardioscopy,

active venous suction, epidural/spinal anesthesia and most recently robotic video assistance in

our surgical repairs of congenital heart defects. We have since found cardioscopy plus/minus

robotics (Aesop 3000 Computer Motion, Goleta, CA) to be an extremely valuable adjuvant for

improving the needed visualization within the restricted confines of a reduced surgical field.

We remain unique in the combination of technologies offered for each patient operated upon.

We receive patients both nationally and internationally. Legitimate concerns over children's safety,

the length of the procedure, and the duration of hospitalization has been addressed in our initial

and/or intermediate experience demonstrating no untoward mortality or significant morbidity.

The diagnosis of fetal cardiac disease can be ascertained as early as 16weeks gestation but usually

requires serial antenatal echocardiograms to follow the dynamic changes within the cardiovascular

system. The development of the cardiovascular system is complete by the 12th week of gestation.

It is believed that the primary defect (which may be initially a small morphological abnormality) can

lead to more severe secondary changes due to the alterations of normal flow and pressures during

the remaining gestational period. Alterations of the primary defects are believed to lessen the severity

of the secondary lesions provided the fetus has time during the third and possibly the second trimester

to undergo alterations in anatomy due to normalization of blood flows and pressures.

The currently philosophy of fetal removal from the confines of the protected uterine mileau, the

institution of cardiopulmonary bypass, the re-implantation of the fetus should be questioned. Since

the triggers for spontaneous delivery of the human fetus are not fully known at this time, the potential

for early and unwanted delivery is real. Fetal demise and lack of time for maturation of the fetal

structures may occur thus making all previous efforts futile. Placenta failure and fetal death

are not uncommon complications of fetal cardiopulmonary bypass.

Alternatives to the latter philosophy have recently included fetoscopy. Micro-manipulation

with long instrumentation inherently amplifies human inadequacies i.e. tremor amplification.

Catheter placement via the umbilical artery in fetal sheep has been successfully accomplished.

We believe the current philosophy of fetal extraction and reinsertion for the treatment of

congenital cardiac conditions remains flawed. Although preliminary, we believe that robotic

in-utero manipulation has merit based upon successful recent laboratory work.