Fetal surgery basics: Who will do my fetal surgery? How to become a fetal surgeon?
Fetal surgery is an up and coming field. It is still new and studies come out to continue to improve outcomes for both mom and fetus(es) that require fetal surgery.
This article has 2 titles because I think this post is important for many people: pregnant women and their families seeking fetal intervention to understand what kind of doctor will care for them, but also for those in the medical field interested in fetal surgery as a career choice.
What kind of doctor is a fetal surgeon?
There are 2 paths to becoming a fetal surgeon.
Most commonly, a fetal surgeon is a maternal fetal medicine (MFM) specialist who specializes in fetal intervention. This means that your surgeon went to medical school, followed by obstetrics and gynecology residency (4 years), maternal fetal medicine fellowship (3 years), then a fetal intervention fellowship (1-2 years).
A fetal surgeon, less commonly, may have went through the surgery route. They would have completed a general surgery residency (5 years), a pediatric surgery fellowship (2 years), and then a fetal intervention fellowship (1-2 years).
As you can imagine, there are advantages to each route, but the ultimate goal is to have a fetal surgeon capable of performing fetal surgeries and managing potential complications.
How is a fetal surgeon trained?
Fetal intervention training used to be informal where an MFM or pediatric surgeon interested in the field is mentored by a fetal surgeon for some months to gain experience before going out to practice on their own. In fact, current older, experienced fetal surgeons went through this route and did not do a fellowship.
Fetal surgery fellowship
Nowadays, there is a structured fellowship in Fetal Intervention. This fellowship is not accredited at this time, which means it is not recognized by ACGME nor ABOG. This means that while it is structured, there is no formal governing body defining the curriculum, how many procedures must be performed before graduation, the skill level required prior to graduation, etc. Each program may do things slightly differently, as opposed to accredited programs like MFM or gynecologic oncology, where all fellow trainees have the same curriculum and have to meet certain milestones to graduate. The decision to graduate a fellow is made at the discretion of the individual program. While all the prior training required, such as OBGYN and MFM, has a board certification, there is also no board certification for fetal surgery.
How do I find a fetal surgeon?
Because there is only a small number of fetal surgeons around the world, you will have to do your own research on the internet, word of mouth, and by referral from your MFM doctor.
Do all fetal surgeons perform the same procedures?
No, not all surgeons perform all procedures.
This is due multiple reasons.
Fetal surgery training is variable. Because of the factors I stated above, not all fetal surgeons are created equal.
Fetal surgeries are uncommon. To have adequate training in all aspects of fetal surgery, and to continue to perform enough to keep up your skills, is rare.
What kind of surgeries do fetal surgeons perform?
Here are some examples of fetal procedures:
Fetoscopic surgey (minimally invasive)
Laser surgery for twin-to-twin transfusion syndrome
Bladder surgery like placing shunts or cystoscopy
FETO: fetal endotracheal occlusion for congenital diaphragmatic hernia
Myelomeningocele (neural tube defects) repair
Heart valve repair
Fetal tumor excision
A collaborative effort
Fetal surgeons may complete the surgery alone, but for bigger surgeries, they work with other surgeons and each surgeon will do their part. For example, in myelomeningocele repair (open neural tube defect), the fetal surgeon enters the mother's abdomen and uterus, and positions the fetus. At that point, the pediatric neurosurgeon is the one that repairs the neural tube defect. Afterwards, the fetal surgeon closes the uterus and abdomen. The fetal surgeon also manages the patient's recovery and any issues that may arise postoperatively.
A collaborative approach is extremely important in all aspects of high risk pregnancy, but especially in fetal surgery.
Multidisciplinary teams can include:
Maternal fetal medicine doctor
Nurses and advanced practice providers
Obstetric anesthesiologist for mom
Pediatric anesthesiologist for baby
Doctors in training (fellows and residents)
Fetal surgery, like all surgery, is highly technical. The rate of complication with fetal surgery for both mom and fetus is quite high - higher than most other surgeries.
Ask your fetal surgery center for their their stats on how many surgeries they perform and their outcomes.
What questions do you have about fetal surgery? Leave them below!
Disclaimer: as you guys already know, I am not a fetal surgeon.
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