New tools help advance keyhole womb surgery

London, UK – The lab at the University College Hospital in London is abuzz with activity.

One team is working on a prototype of an extremely high-resolution ultrasound for an unborn baby: the veins are bright pink and the placenta a swirling grey.

Another is putting a tiny flexible probe through a hole in a cardboard box: a tool for practising keyhole surgery, while a third group is using a robotic hand to manipulate a tiny probe in a plastic box filled with water designed to replicate the womb.

It is all part of a seven-year, $17m programme to develop tools for keyhole womb surgery.

The “low-hanging fruit” – the project easiest to achieve – is a foetalscope, the high-resolution ultrasound that provides a map of the placenta.

It will give surgeons a much better picture of what they’re doing, the project’s director, Seb Ourselin, told Al Jazeera as engineers and computer scientists whirled around the lab, fixing cables, working on connections and manoeuvring robotic arms.

The high-tech scanning machine takes a series of pictures and puts together a complete view of the womb, much like you do when you take a panorama with your smartphone camera.

It allows surgeons to see on a screen in front of them in the operating room exactly where they are working in the womb, often a confusing and challenging environment.

“It’s like painting the back of the door through the keyhole,” explained Jan Deprest, one of Europe’s pre-eminent foetal surgeons.

The tools will allow doctors such as Deprest to go places they couldn’t see and work in areas they couldn’t reach.

When Anna David, an obstetrician at the University College Hospital, scans her patients she can detect birth defects as early as 12 weeks, when the foetus is the size of a tangerine.

But surgery would be too risky on a foetus that small. Frustratingly, there’s often nothing the doctors can do but watch problems develop.

“One of the constraining factors is we know that if we put a scope into the womb very early on, there is a much higher risk of the membranes around the baby rupturing because you’ve made a hole in the womb that is about the size of my finger,” David told me between patients during a busy afternoon at the Preterm Birth Clinic.

“Whereas if you had just a very fine needle you’d be able to actually treat the baby and the woman wouldn’t go into labour early and the outcome would be better.”

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As the foetus grows, surgery can be done by opening the mother’s stomach, but that is often extremely risky and sometimes leaves the woman unable to have another child.

The need is clearly there, but the science is complex. A team of 41 engineers, chemists, computer scientists and ethicists at University College London are working with colleagues at KU Leuven in Belgium.

The scientists come from across the globe: France, China, Colombia, Turkey.

One day they are hoping to see routine keyhole surgery on pregnant women.

The surgeons would use a tiny flexible probe that will carry a camera, scalpel or laser and be guided by a robotic hand to compensate for unsteady hands.

A fairly common birth defect – spina bifida, where the spinal cord grows outside of the baby’s body – “is the holy grail”, Ourselin explained.

Keyhole surgery would allow the condition to be repaired before it develops and does permanent damage to the baby.

And there are applications for the tools beyond foetal surgery.

“At the moment when you do surgery on children you will actually use tools which have been manufactured for adults,” Ourselin said.

“They might be too big, they might be quite clunky and they might not be able to do the right job at the right place within the body.

“So if we actually manage to make these minimally invasive surgery tools to transform the way we do foetal surgery at the moment, we will eventually transform the way we do paediatrics surgery as well.”