{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T06:36:29Z","timestamp":1762065389510,"version":"build-2065373602"},"reference-count":58,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: The aim of this review is to discuss experimental and clinical techniques and interventions of fetal surgery which have been performed minimally invasively by the means of a three-port approach for the fetoscope and instruments for the left and right hand of the surgeon (bimanual minimally invasive fetal surgery). Methods: a print and electronic literature search was performed; the titles and abstracts were screened and included reports were reviewed in a two-step approach. First, reports other than minimally invasive fetal surgery were excluded, then a full text review and analysis of the reported data was performed. Results: 17 reports were included. The heterogeneity of the included reports was high. Although reports on human fetoscopic surgical procedures can be found, most of them do not pick out bimanual fetal surgery as a central theme but rather address interventions applying a fetoscope with a working channel for a laser fiber, needle or flexible instrument. Most reports were on experimentation in animal models, the human application of minimally invasive fetoscopic bimanual surgery is rare and has at best been explored for the prenatal treatment of spina bifida. Some reported bimanual fetoscopic procedures were performed on the exteriorized uterus via a maternal laparotomy and can therefore not be classified as being truly minimally invasive. Discussion: our results demonstrate that minimally invasive fetoscopic bimanual surgery is rare, even in animal models, excluding many other techniques and procedures that are loosely termed \u2018minimally invasive fetal surgery\u2019 which we suggest to better label as \u2018interventions\u2019. Thus, more research on percutaneous minimally invasive bimanual fetoscopic surgery is warranted, with the aim to reduce the maternal, uterine and fetal trauma for correction of congenital malformations.<\/jats:p>","DOI":"10.3390\/children9091377","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T21:06:52Z","timestamp":1663103212000},"page":"1377","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Minimally Invasive Bimanual Fetal Surgery\u2014A Review"],"prefix":"10.3390","volume":"9","author":[{"given":"Susanne Eva","family":"Brunner","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4924-2599","authenticated-orcid":false,"given":"Lidya-Olgu","family":"Durmaz","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2043-8726","authenticated-orcid":false,"given":"Andreas","family":"Meinzer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Arp","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3102-7268","authenticated-orcid":false,"given":"Thomas Franz","family":"Krebs","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"},{"name":"Department of Pediatric Surgery, Children\u2019s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-8440","authenticated-orcid":false,"given":"Robert","family":"Bergholz","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1093\/bjs\/znaa153","article-title":"Fetal Surgery","volume":"108","author":"Sampat","year":"2021","journal-title":"Br. 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