Surgeons will be able to use better tools, imaging techniques and therapies in future operations on unborn babies due to a £10 million (€12.5 million) award from the Wellcome Trust and the Engineering and Physical Sciences Research Council (EPSRC) to develop these technologies. Pioneered in the 1980s, surgery on unborn babies has been shown to be effective to treat conditions arising before birth like spina bifida, where a lesion on the back leaves the spinal cord exposed in the womb, and twin-twin transfusion syndrome, where blood passes unequally between twins who share a placenta. Now, research led by engineers at University College London (UCL) and Katholieke Universiteit Leuven in Belgium will develop novel imaging techniques that can be used before and during surgery to visualise blood circulation, enabling surgeons to better plan and perform operations on unborn babies with severe birth defects. The project has been funded by the Wellcome Trust and EPSRC under the 'Innovative Engineering for Health' initiative, which also involves paediatric surgeons and doctors at Great Ormond Street Hospital and University College London Hospital NHS Trust. In addition to working on surgical imaging techniques, the team will develop new instruments to improve the flexibility and precision of the surgeon, as well as adaptations to deliver stem cell therapies to the unborn baby in the womb. A training platform will also be developed that will enable surgeons to gain the necessary skills before operating on pregnant mothers. SURGERY IN THE WOMB [caption id="attachment_14821" align="alignright" width="460"] Image courtesy of EPSRC/Wellcome Trust (click to enlarge)[/caption] In the UK, around one in a hundred babies are born every year with a severe birth defect, and collectively these are estimated to be responsible for over a third of all paediatric hospital admissions and up to a half of the total cost of paediatric hospital treatment. About one in 1,000 babies in the UK are born with myelomeningocele spina bifida, the most serious form of spinal bifida. This is caused when the spine of an unborn baby does not form properly and amniotic fluid leaks into it. Birth defects are usually detected prenatally by screening with ultrasound and some of these can benefit from surgical correction because therapy cannot wait until after birth. Performing surgery whilst the foetus is still in the womb improves survival chances and significantly reduces life-time disability. The Wellcome-funded project is aimed at developing instruments based on the latest optics and robotics. A very thin, highly flexible probe would be inserted into the womb of a woman carrying a child with spina bifida. The head of the probe would have one strand fitted with a tiny camera that would use laser pulses and ultrasound detection – a combination known as photo-acoustic imaging – to generate a 3D image inside the womb. The probe's other arms would also be fitted with tiny instruments that would carry a piece of gel or patch that would be laid over the gap in the baby's spine, which would act like a plaster. Currently, most robotic designs are for a three-pronged device that has one arm fitted with a camera and two that are fitted with pincers or other instruments. "We’re still in the design stage, so we could end up with a device with four or five arms in the end," said Prof Sebastien Ourselin, of the UCL Centre for Medical Image Computing, who is leading the research. Operating on babies in the womb is not undertaken lightly and is reserved for just a handful of the most severe defects. Such surgery involves opening the mother's abdomen and uterus and incurs a significant risk of triggering premature birth. Very few procedures can be done safely in the foetus using keyhole surgery, and more complex ones require opening the uterus, which puts both the mother and unborn baby at risk. Fewer than 1,000 procedures a year have been attempted at various specialised clinics around the world. In addition, surgery on the unborn can only be carried out when the unborn baby is at least 26 weeks old. By that time, in the case of spina bifida, considerable damage may already have been done to the child's growing brain. Ideally, ‘blocking the gap’ in the baby’s spine should be done around 16 weeks’ gestation. The earlier the treatment, the more effective it will be. COMBINING TECHNOLOGIES “Our aim is to combine less invasive surgical technologies with stem cell and gene therapies to treat a wide range of diseases in the womb, with considerably less risk to both mother and baby," added Prof Ourselin. Dr Ted Bianco, director of technology transfer at the Wellcome Trust, said that developing the tools surgeons needed to improve foetal surgery would be “transformative”, both in treating severe birth defects and in developing the next generation of surgical technology. “Whilst it may be many years before the full potential of the research will be realised, the size and duration of the awards from the Trust and EPSRC are designed to enable our award holders to be bold in their approach,” he added. Prof Philip Nelson, chief executive of EPSRC, said the research showed how engineering and scientific developments could save and improve lives. He added that it would hopefully improve the survival chances of unborn children by making foetal surgery safer and treatment better focused. Mr Paolo de Coppi, consultant paediatric surgeon at Great Ormond Street Hospital, who is leading on that hospital’s involvement in the project, said that as the safety of foetal surgery increased, it was possible that many of the operations that were currently performed on newborn babies at Great Ormond Street would become foetal procedures. “That’s very good news for a child’s long term outlook, because the earlier we can correct a serious defect in a growing foetus, the better the outcome is likely to be for the child and their future development,” de Coppi concluded.