Learning curves of open and endoscopic fetal spina bifida closure: systematic review and meta‐analysis

摘要: OBJECTIVE The Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy open fetal surgery for spina bifida aperta (SBA). Recently developed alternative techniques may reduce maternal risks without compromising neuroprotective effects. aim this systematic review was to assess learning curve (LC) different SBA closure techniques. METHODS MEDLINE, Web Science, EMBASE, Scopus Cochrane databases gray literature were searched identify relevant articles on SBA, language restriction, published between January 1980 October 2018. Identified studies reviewed systematically those reporting all consecutive procedures with postnatal follow-up ≥ 12 months selected. Studies included only if they reported outcome variables necessary measure LC, as defined by efficacy. Two authors independently retrieved data, assessed quality categorized observations into blocks 30 patients. For meta-analysis, data pooled using a random-effects model when heterogeneous. To we used two complementary methods. In group-splitting method, competency procedure provided results comparable in MOMS 12 representing immediate surgical outcome, short-term neonatal neuroprotection long-term at age. Then, raw patient available, performed cumulative sum analysis based composite binary defining successful surgery. combined four clinically (absence extreme preterm delivery < 30 weeks, absence death ≤ 7 days after surgery) (reversal hindbrain herniation any treatment dehiscence or cerebrospinal fluid leakage site). RESULTS Of 6024 search results, 17 (0.3%) included, which had low, moderate unclear risk bias. Fetal standard hysterotomy (11 studies), mini-hysterotomy (one study) fetoscopy either exteriorized-uterus single-layer study), percutaneous (three studies) two-layer study). Only outcomes could be meta-analyzed. Overall, improved significantly experience. Competency reached 35 cases predicted achieved ≥ 57 ≥ 56 fetoscopy. fetoscopy, not 81 28 available analysis, respectively, LC prediction performed. CONCLUSIONS number operated is correlated closure, required reach ranges from ≥ 56-57 minimally invasive modifications. Our provide important information institutions looking establish new center, develop technique train their team, inform referring clinicians, potential patients third parties. Copyright © 2019 ISUOG. Published John Wiley & Sons Ltd.