An oral teratoma - a mouth tumor - was successfully removed from a fetus while still in the womb via operative fetoscopy, doctors from Jackson Memorial Hospital, Florida, reported in the American Journal of Obstetrics & Gynecology. The medical team says this procedure is a "world first".

The authors explained, as background information, that prenatal diagnoses of nasopharyngeal teratomas, which make up just 9% of all teratomas, carry a very grave prognosis. In all previous cases of diagnoses made before birth, the babies have either died at or soon after birth, or required multiple postnatal surgeries. If the tumor could be safely treated while the fetus were still in the uterus (womb), these complications could be averted.

Dr. Ruben A Quintero and team set out to treat an oral teratoma via operative fetoscopy in a fetus. They reported that the baby was successfully treated while in the uterus and was "a healthy infant at term" (was born a healthy baby).

Mother saw a "bubble" coming out of her fetus' mouth

Tammy Gonzalez, the baby's mother, underwent an ultrasound scan at 17 weeks of pregnancy. She explained in a press conference that she was able to see a "bubble" coming out of the fetus' mouth. After further diagnostic scans, including magnetic resonance imaging (MRI), doctors told her that her baby had a rare tumor, an oral teratoma. They added that her daughter's chances of survival were very small.

The doctors told Tammy that they could carry out a new type of surgery which might save the fetus. After serious consideration, the mother requested to undergo fetoscopy. She had been told that the risk of pregnancy loss was estimated at 5%. The surgical procedure was approved by the University of Miami and Jackson Hospital under the innovative therapy pathway.

The medical team placed Mrs Gonzalez under a local anesthetic and pushed an endoscope through the amniotic sac around the fetus. Laser was used to surgically remove the tumor. Five months after this one-hour operation, when mother was 38.5 weeks pregnant, little Leyla was born vaginally, weighing 8lb 1oz (3.7kg). Childbirth occurred without any complications.

When Leyla was one month old, MRI scans showed no evidence of tumor recurrence in the brain or face.

The authors explained that this type of tumor is very rare, and had only been recorded once at the hospital during the last twenty years.

In a press conference in Miami, Mrs Gonzalez said:

"When they finally severed the whole thing off and I could see it floating down, it was like this huge weight had been lifted off me and I could finally see her face."

The authors wrote in an Abstract in the journal:

"Our case suggests that in utero fetoscopic management of fetuses with oral teratomas may be feasible in selected cases. In utero endoscopic assessment or treatment may allow parents to make a better educated decision about their management of the pregnancy.

If done early enough, as in our case, fetoscopic removal of the teratoma may avoid further growth of the mass, distortion of the facial structures, micrognathia, development of polyhydramnios, airway obstruction, the need for an EXIT or OOPS procedure, and the need for cesarean section delivery."

What is fetoscopy?

Fetoscopy allows the doctor access to the fetus during pregnancy, as well as the amniotic cavity, the fetal side of the placenta and the umbilical cord.

The surgeon makes a small incision in the abdomen and a fetoscope (endoscope) is inserted through the abdominal wall and the uterus, and enters the amniotic cavity.

This procedure allows the surgeon to carry out biopsies, laser occlusions of abnormal blood vessels, and excisions of tumors (as occurred in this case). Dr. Ruben Quintero developed the field of surgical fetoscopy.

Written by Christian Nordqvist