Surgery in the womb to be improved by research into new tools and imaging techniques

Surgeons will be able to use better tools, imaging techniques and therapies in future operations on unborn babies due to a £10 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 for treating 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 UCL (University College London) and KU 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 Hospitals NHS Foundation 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.

Around one in a hundred babies are born 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.

Birth defects are usually detected prenatally by screening with ultrasound and in some cases therapy cannot wait until after birth. Performing surgery while the fetus is still in the womb can improve survival chances and significantly reduce lifetime disability.

Professor Sebastien Ourselin from the UCL Centre for Medical Image Computing, who is leading the research, said: "Operating on babies in the womb is not undertaken lightly and is reserved for just a handful of the most severe defects. Very few procedures can be done safely in the fetus using keyhole surgery, and more complex ones require opening the uterus, which puts both the mother and unborn baby at risk. Less than 1,000 procedures a year have been attempted at various specialised clinics around the world.

“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."

Dr Ted Bianco, Director of Technology Transfer at the Wellcome Trust, said: "Developing the tools surgeons need to improve fetal surgery will 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.”

Professor Philip Nelson, Chief Executive of EPSRC, said: "This research shows how engineering and scientific developments can save and improve lives. We are very proud to be working in partnership with the Wellcome Trust to support this research. Hopefully it will improve the survival chances of unborn children by making fetal surgery safer and treatment better focused."

Mr Paolo de Coppi, consultant paediatric surgeon at Great Ormond Street Hospital, who is leading on GOSH’s involvement in the project, said: “As the safety of fetal surgery increases, it is possible that many of the operations that we currently perform on newborn babies at Great Ormond Street will become fetal 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 fetus, the better the outcome is likely to be for the child and their future development.”