Belgium leads the world in the field of foetal therapy, surgical operations which are undertaken in utero. One of the leading specialists is Professor Jacques Jani from the Brugmann Hospital in Brussels who was recently called to Rome, Italy to carry out a very delicate operation.
Professor Jani was called in May to the famous Gemelli Hospital, known as the Hospital of the Popes, in the Italian capital to attend to a patient with TTTS syndrome, a twin-to-twin transfusion, in the womb. It is a pathology that affects 10% of monochorionic pregnancies, in which babies are dependent on a single, shared placenta. One of the babies receives too much blood and urinates a lot, at the expense of the twin who is wasting away without food and whose kidneys are not functioning.
The operation would take place in the new foetal surgery centre at the Gemelli Hospital, which is ranked among the forty best hospitals in the world. Dr Elisa Bevilacqua, a specialist in twin pregnancies at the Gemelli Polyclinic who was mentored by Professor Jani during her doctorate in Brussels, immediately called him when it became clear that only an operation could save the babies.
Short-notice operation
"I performed more than one hundred and fifty operations in utero abroad,” explains Professor Jani, “but I had never operated at the Gemelli. Not many of us in Europe agree to leave at short notice to operate in a foreign hospital with a team of unknown doctors.
When Dr Bevilacqua called, I took the first flight and, on the way, I telephoned to tell them to prepare the operating room because what use is my knowledge if not to pass it on to foreign doctors with whom I have already worked in Brugmann?"
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"With such an operation we burn the blood vessels to separate the placenta in two,” says Dr Bevilacqua. “But in this case, there was also an excess of amniotic fluid that made the pregnancy very dangerous and very uncomfortable. It was necessary to separate the placenta and puncture seven litres of amniotic fluid."
The operation is done by endoscopy with instruments whose diameter barely exceeds one millimetre. In 15% of cases, these operations cause the rupture of the gestational sac, and therefore the death of the foetuses.
"We make a single small incision in the mother's womb, and the operation must be fast, a maximum of thirty minutes to avoid the rupture of the gestational sac,” explains Professor Jani, who studied in London with Kypros Nicolaides, the inventor of in utero foetal surgery.
"Without the doctor, they would not be here"
Nine weeks after the procedure, Dr Jani returned to Rome to meet the mother and her babies, Alessandro and Christian, already considered small miracles. The possibility of saving both children is rare.
"Without the doctor, they would not be here," says Felicia Scanu, the young mother from Naples. "I was very concerned because I knew there were risks for this operation, but without it, there was no possibility of arriving at birth, at twenty-five weeks. I had seven litres of extra amniotic fluid and excruciating pain."
Alessandro and Christian are still very fragile, but they were born at thirty-five weeks. They start life with a beautiful story, that of a doctor who came from the North just to save them.
