Fetal surgery for lung lesions, congenital diaphragmatic hernia, and sacrococcygeal teratoma.

After more than 2 decades of experimental and clinical work, fetal surgery is an accepted treatment option for highly selected fetuses with life-threatening anomalies. Fetal lung masses associated with hydrops are nearly 100% fatal. These lesions can be resected in utero if they are predominantly solid or multicystic. Thoracoamniotic shunt placement may be effective in the setting of a single large cyst. Fetuses diagnosed with left congenital diaphragmatic hernia before 26 weeks' gestation with associated liver herniation and a low right lung to head circumference ratio have a relatively poor prognosis with conventional therapy after birth, but in utero therapeutic approaches have yet to show a comparative survival benefit. A prospective randomized trial is required to critically evaluate the efficacy of fetal tracheal occlusion for severe diaphragmatic hernia. Fetal sacrococcygeal teratoma complicated with progressive high output cardiac failure may benefit from in utero resection of the tumor.