Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 28, 2015; 5(2): 198-207
Published online Jul 28, 2015. doi: 10.5412/wjsp.v5.i2.198
In utero and exo utero fetal surgery on histogenesis of organs in animals
Esrat Jahan, Ashiq Mahmood Rafiq, Hiroki Otani
Esrat Jahan, Ashiq Mahmood Rafiq, Hiroki Otani, Department of Developmental Biology, Faculty of Medicine, Shimane University, Izumo-shi 693-8501, Shimane, Japan
Author contributions: Jahan E conceived, designed and drafted the paper; Rafiq AM drafted the references; Otani H ideated, guided and reviewed the paper.
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hiroki Otani, MD, PhD, Professor, Department of Developmental Biology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo-shi 693-8501, Shimane, Japan.
Telephone: +81-853-202102 Fax: +81-853-202100
Received: September 27, 2014
Peer-review started: September 28, 2014
First decision: December 17, 2014
Revised: February 22, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: July 28, 2015

Until recently, fetal surgery was only used for fetuses with very poor prognosis who were likely to die without intervention. With advances in imaging, endoscopic techniques, anesthesia and novel interventions, fetal surgery is becoming a realistic option for conditions with less severe prognoses, where the aim is now to improve quality of life rather than simply allow survival. Until forty years ago, the uterus shielded the fetus from observation and therapy. Rapid changes in the diagnosis and treatment of human fetal anatomical abnormalities are due to improved fetal imaging studies, fetal sampling techniques (e.g., amniocentesis and chorionic villus sampling), and a better understanding of fetal pathophysiology derived from laboratory animals. Fetal therapy is the logical culmination of progress in fetal diagnosis. In other words, the fetus is now a patient. Now-a-days, in utero (IU) and exo utero (EU) surgical methods are popular for experimental analyses of the histogenesis of organ development. Using these surgical methods, developmental anomalies can be created and then repaired. By applying microinjection and/or fetal surgery with these methods, models of developmental anomalies such as neural tube defects, temporomandibular joint defects, hip joint defects, digit amputation, limb and digit development and regeneration, and tooth germ transplantation in the jaw could be created and later observed. After observing different types of anomalies, novel IU and EU surgical techniques would be the best approach for repairing or treating those anomalies or diseases. This review will focus on the rationale for the IU and EU creation of animal models of different organ defects or anomalies and their repair, based on analyses of organ histogenesis and pathologic observations. It will also focus in detail on the surgical techniques of both IU and EU methods.

Keywords: Myelomeningocele, Microinjection, Rodent, Sheep, Neural tube defect, Temporomandibular joint, Fetal surgery, In utero, Exo utero

Core tip: Fetal surgery in animal models has become a promising technique for analyses of organ histogenesis and organogenesis. Using unique in utero (IU) and exo utero (EU) methods, developmental anomalies could be created and repaired during the prenatal period. Here, we review the IU and EU surgical techniques, focusing on methods and outcomes in various experimental animals.