>> Fetal surgery for spina bifida 
is an incredibly complex procedure.
At Children's Hospital of Philadelphia, where
the surgery was developed, a team of more
than 20 people are in the operating room.
They include up to four fetal surgeons, one
neurosurgeon, two anesthesiologists, a maternal
fetal medicine specialist, a fetal cardiologist
and specialized nurses.
They have performed this procedure 
more than any team in the world.
Before surgery, the mother receives 
deep general anesthesia.
Fetal surgeons make an incision
across the mother's abdomen.
The maternal fetal medicine specialist uses
ultrasound to determine the position of the
fetus and the margins of the placenta.
The uterus is then opened with a specially
designed uterine stapling device that controls
bleeding, and the fetus is positioned so the
spinal defect is visible.
The fetal cardiologist monitors the baby's
heart as the team closes the defect.
The neurosurgeon removes a sac on the baby's
back that covers the opening in the spinal cord.
The sac is a thin membrane filled with fluid.
The neurosurgeon and the fetal surgeon then
close the defect in multiple layers using
a lacing technique.
First the muscle layers are 
closed over the defect.
Then the skin is closed over the muscle layers.
This ensures a watertight closure.
The mother's uterus is closed in multiple
layers, then her abdomen is closed and she
is returned to her room.
The pregnancy then continues until planned
delivery at 37 weeks' gestation, most often
in our Special Delivery Unit created for
moms carrying babies with birth defects.
♪♪
