Fascinating footage has given a behind-the-scenes glimpse at how pioneering surgery is performed on a foetus while it’s still in the womb.
Dr Wael El Banna filmed a procedure he performed on a baby in utero to repair the beginnings of the birth defect spina bifida.
The clip shows him pulling the fluid-filled womb out of the mother’s abdomen, draining liquid through a tube and performing intricate surgery on the baby inside.
Dr El Banna, from Egypt, said his operation was the first of its kind to be performed in the region and mother and baby have been ‘doing great’ since the op this month.
He revealed the procedure to MailOnline just days after a mother in England spoke of her delight at having a healthy baby after the same operation – the NHS is preparing to start offering the op later this year.
During the operation, Dr El Banna (pictured operating) pulled the mother-to-be’s womb out of an incision in her abdomen in order to get better access to the unborn baby
Dr El Banna and a team of 11 medics completed the five-hour operation on Thursday, April 11, at Gohar Hospital in Cairo.
The unidentified patient, a 36-year-old woman from Saudi Arabia, was 26 weeks pregnant at the time.
Dr El Banna, a 38-year-old esteemed gynaecologist, told MailOnline: ‘During her antenatal ultrasound she was discovered to have a defect in the back of her foetus.
‘Bravely she decided to go through the battle of open fetal surgery and refused the abortion option totally.
‘Her words were so touching – “I know that he will suffer and I will do anything to help him”.’
The baby had been found to have a hindbrain herniation, a deformity in which part of the brain is pulled out the back of the skull by the spine and down the neck.
This can cause spina bifida, a condition which begins before birth and develops when nerves are exposed and left at risk of damage.
Dr El Banna was part of a team of 11 medics including neurosurgeons, nurses and who worked together on the five-hour operation in Gohar Hospital in Cairo, Egypt
During the pioneering spina bifida surgery, surgeons drain some of the fluid from the amniotic sac and try to repair the spinal column to protect exposed nerves which can cause disability
WHAT IS SPINA BIFIDA?
Spina bifida is a fault in the development of the spine and spinal cord that leaves a gap in the spine.
About 1,500 babies are born with spina bifida each year in the US, according to the CDC. In the UK, approximately one in 1,000 babies are born with the condition.
Most cases are detected before birth, at the 20-week scan.
The most serious form of the disease is called myelomeningocele. In myelomeningocele, the spinal column remains open along the bones making up the spine.
The membranes and spinal cord push out to create a sac in the baby’s back.
This sometimes leaves the nervous system vulnerable to infections that may be fatal.
In most cases surgery is carried out to close the gap in the spine after birth.
But damage to the nervous system will usually already have taken place, resulting in:
Most babies with myelomeningocele will also develop hydrocephalus, with excess cerebrospinal fluid (CSF) pooling inside the brain.
This is caused by a malformation at the base of the skull in which the lower parts of the brain are pushed down towards the spinal cord.
Babies with hydrocephalus are fitted with a shunt after birth to divert the fluid from the brain, so reducing the risk of increasing cranial pressure, into the abdominal cavity.
When nerves are damaged it can leave sufferers with weak or paralysed leg muscles, bowel or bladder incontinence, or reduced sensation in the lower body.
It can also lead to a build-up of fluid in the skull which can cause further brain damage and potentially learning difficulties.
In the UK, as many as 80 per cent of parents who find out their unborn child has spina bifida opt for a termination.
In this type of pioneering surgery, doctors are now able to correct malformations in the spine in the hope of protecting nerves and preventing crippling damage.
‘We opened the abdomen and got the womb out,’ Dr El Banna said.
‘We located the position of the foetus and then manipulated his body to face the small opening that we made in the womb.
‘Then [we] drained some of the fluid around the foetus and kept the foetus under monitoring through the whole surgery.
‘The defect was repaired successfully and the fluid was injected back around the foetus and the womb and abdomen were closed.
‘She [the mother] was put in a strict post-operative protocol and, thank God, the foetus and the mother are doing well.’
The footage of Dr El Banna, who has trained at King’s College London and a clinic on Harley Street, shows him pull the woman’s swollen womb out through an incision on her stomach.
He works with a team of medics including nurses, obstetricians, neurosurgeons and a paediatrician.
Dr El Banna feels the football-sized pouch to find where the foetus is and moves it into a suitable position for surgery, away from the placenta to avoid damaging the organ.
After the keyhole surgery is completed the amniotic fluid can be put back into the womb and the organ sewn back up like after normal operations
Dr El Banna, pictured draining amniotic fluid through a tube called a trocar, said there are ‘lots of things which could go wrong’ with the relatively new operation
The procedure Dr El Banna filmed is the first of its kind to be performed in the Africa and Middle East region, he said – he believes it will be the future of spina bifida treatment
Then a trocar, a drainage pipe, is pushed through the lining of the womb to drain some of the amniotic fluid.
The team of surgeons and anaesthetists then proceed with the groundbreaking operation to repair the baby’s spine before replacing drained amniotic fluid and closing the womb and the mother’s abdomen.
Dr El Banna added: ‘There are lots of technical complications and lots of things which could go wrong with this procedure.
WHAT IS FOETAL REPAIR FOR SPINA BIFIDA?
Foetal repair for spina bifida is a delicate operation in which surgeons open the womb and close the opening in the back of the baby’s head while it is still in the uterus.
Spinal cord damage worsens during pregnancy, therefore this procedure can help prevent the condition becoming more severe.
It does not cure the condition but studies show it can lead to significantly better results than surgery carried out after the baby has been born.
The procedure also boosts the child’s chances of having good mobility and being able to walk independently.
It takes place between 19 and 25 weeks into the pregnancy.
The mother requires a general anaesthetic that relaxes the uterus and acts as a painkiller for the baby.
A surgeon then cuts an incision across the mother’s abdomen and positions the baby’s spinal cord to the spinal canal.
The doctor also closes surrounding tissue and skin to protect the spinal cord from exposure to amniotic fluid.
‘But the mother was brave and she didn’t want her son to be disabled and she didn’t want an abortion.
‘This operation has been performed for years in the US and children have better walking and less urinary and bowel incontinence.’
Dr El Banna said bleeding and blood clots are possible complications of the surgery, and the foetus’s life is at risk because the womb is inflated with air for the operation.
But his procedure went well and a scan seven days afterwards showed the baby’s spine now looks healthier and the mother was well and walking around after 10 days.
And this type of in-utero surgery, best performed between the 22nd and 26th week of pregnancy, will be the way forward for surgeons in the future, Dr El Banna said.
Earlier this month, English mother Bethan Simpson, from Essex, revealed her delight at having a healthy baby after she had the same surgery in London in January.
Her operation was performed at University College Hospital and a team of 20 medics spent five hours working to save her baby from spina bifida.
Three months after the operation, on April 1, 26-year-old Mrs Simpson gave birth to her daughter Eloise, conceived through IVF, and was told she was healthy.
Mrs Simpson, a nurse, said: ‘Her legs kick, her toes curl. Bless her, she doesn’t even know the impact she has had.
‘It’s a miracle, that’s the only way I can describe it. We may have been through a lot, but I’d do it for Elouise all over again in a heartbeat.’
Mrs Simpson was the fourth woman to have the procedure in Britain, which was paid for by charity funding – it is set to become more widely available on the NHS this year.
‘IT’S A MIRACLE’: BRITISH MOTHER HAS HEALTHY DAUGHTER AFTER SPINA BIFIDA WOMB SURGERY
Bethan Simpson, 26, gave birth to her daughter Elouise this month after having surgery while still pregnant to try and prevent her baby’s spina bifida.
The first-time mother, from Burnham-on-Crouch in Essex, had at least 20 hospital visits as doctors decided what to do about her daughter’s birth defect.
In January she became only the fourth woman in Britain to have the groundbreaking surgery done on her child while the baby was in the womb.
The Simpsons began IVF treatment in 2018 after three years trying for a baby. It worked on the second attempt and, overjoyed, they began planning for the new arrival (Pictured: Bethan and Kieron Simpson with their daughter Elouise)
Elouise was discharged from hospital at the beginning of April and showed no signs of spina bifida, which could have left her with lifelong disabilities.
She had been conceived after Mrs Simpson and her husband, Kieron, 28, used IVF after three years of struggling to get pregnant.
Looking adoringly at her daughter, Mrs Simpson, a nurse, said: ‘It didn’t sink in that we were going to have a healthy baby until she arrived.
‘Just because she was kicking in the womb didn’t mean it would happen outside.’
It is possible that Elouise could suffer some effects of the spina bifida but, if she does, they are expected to be minimal
But she gave birth on April 1 and was told the baby was healthy.
‘I was so elated,’ Mrs Simpson said. ‘We were crying happy tears for about ten minutes. After the birth Elouise went through a series of tests. Each time she passed one it was momentous.’