Surgery in utero

Sometimes television can change lives. When Thomas Kohl was studying medicine in Essen, he happened to see a TV report one evening about Michael Harrison, the first surgeon in the world to perform surgery on a fetus while still in the womb. From that moment on, Kohl knew what he wanted to do. Several years later he spent three research years at the University of California at San Francisco, where Harrison also worked. He began to develop minimal invasive surgery techniques using sheep fetuses. Today, the now 40-year-old pediatrician and prenatal physician is setting up a working group for Human Fetal Surgery at the University Clinic in Bonn. In 2002 the first endoscopic surgery was performed on a fetus with a cleft spine, (Spina bifida). Through a trocar as thin as a straw, Kohl covered the exposed spinal cord with a tiny Teflon patch. It was extremely delicate work – the diameter of the trocar was just one third the usual size in endoscopic procedures.

Operations on the unborn with a life-threatening congenital diaphragmatic hernia are another planned area of application for fetal surgery. With this birth defect, the organs in the abdomen protrude into the chest cavity, thus impairing normal lung growth. In addition, Kohl is developing prenatal heart surgery at the University of Muenster. In trial tests his team was already successful in correcting heart defects in fetal sheep.

If such surgery becomes routine procedure, Dr. Kohl and his staff will have a lot of work on their hands. About one baby in 3,000 is born with a cleft spine today, and the statistics for congenital diaphragmatic hernia are similar. Eight in 1,000 newborn babies have a heart defect. Thomas Kohl’s thesis required for his qualification as a university lecturer, entitled on the “Development of Fetoscopic Surgical Methods,” was awarded the Werner Forssmann Prize, which is presented every year by the Board of Cardiology 2000 of the University of Bochum.