(1083) Needle Lasso Technique for Port Site Closure During Fetoscopic Spina Bifida Repair

Objective:
To describe the first clinical application of a needle lasso technique adapted from pediatric inguinal hernia repair (PIRS) for port site closure during fetoscopic spina bifida repair, aimed at reducing PPROM and chorioamniotic separation.

Study Design:
We implemented the needle lasso technique in three consecutive cases undergoing fetoscopic spina bifida repair at our center—two via laparotomy-assisted and one via mini-laparotomy approach. Following fetoscopic access using two 3-mm and one 5-mm uterine cannulas, 3-0 Prolene loop sutures mounted on 18G spinal needles were inserted transmyometrially to encircle each port site. A 3-0 PDS suture was passed via a 20G needle on the opposite side and retrieved through the loop to form a full-thickness port-site stitch, anchoring the membranes to the uterine wall [Figure 1]. Each port was closed with 3–4 stitches forming triangular or square plications.

Results:
All three pregnancies were prolonged beyond 34 weeks with no incidence of PPROM or chorioamniotic separation. The technique allowed for real-time visualization and precise closure of the port sites, with visible approximation of the membranes to the uterine wall [Figure 2]. No maternal or fetal complications were observed.

Conclusion:
The needle lasso technique offers a simple, effective method for port site closure during fetoscopic spina bifida repair. Adapted from a proven pediatric surgical technique, it provides membrane plication under direct visualization and may help mitigate postoperative complications such as PPROM. Integration with emerging magnetic or mechanical suture-passing devices may further improve its reproducibility and ease of use in minimally invasive fetal surgery.