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Chat: Dr Chris Kimber

Monday, July 18, 2011

Interviewer: Dr Kimber, thank you for talking to us tonight, in our live online chat room.

Chris Kimber: Thanks for coming everyone, I hope I can answer all your questions.

Flutters asks: Hi Dr Kimber, how long has this kind of invitro operation been used?

Chris Kimber: Question is which one, but I suppose various techniques have now been used for decades.

James asks: What types of surgery can be performed on babies in the womb?

Chris Kimber: You can divide tissue that is causing blockage to limbs, or you can try and unblocked a blocked bladder and kidney, and you may wish to try and treat a very dangerous tumour. So there are a few different operations.

Matthew asks: What type of criteria do you use before doing this type of surgery?

Chris Kimber: We would spend a lot of time counselling the mother about options and, and we'd spend a lot of time doing blood test and ultra sound to ensure the baby was otherwise normal.

Robbie asks: When did you first gain interest in Paediatric medicine?

Chris Kimber: I think in 1985 when I worked with Professor MacMan in the Queen Vitoria hospital.

Flutters asks: Dr Kimber, at what stage in a pregnancy, is it "safe" to do these operations?

Chris Kimber: It's different for many different conditions, but we've done operations in the womb as low as 20 weeks.

Ben_Sefton asks: What is the success rate of in utero surgery?

Chris Kimber: The success rate various between the conditions, so there are many conditions we operate for. There is a real risk the foetus can be harmed or damaged, but the success rate is increasing significantly. Also many of these conditions are so rare, so it's difficult to give an accurate success rate.

becs asks: Is there a treatment like this that can repair a twisted cord?

Chris Kimber: If we knew the cord was twisted and that was the only problem, and it was detected at the right age, then technically it would be possible to untwist. But it is often not detected or picked up too late.

kadst asks: I find this absolutely amazing. We are so lucky to live in a time where we have this technology and such smart people. Are these procedures covered by the NHS?

Chris Kimber: All the procedures that we perform as done in public hospitals and provided by the government, so there is no cost.

jonocass asks: Dr Kimber - is there any advances on intrauterine shunting to treat Hydrocephalus?

Chris Kimber: It's not my area of expertise, but we can now perform MRI scanning on the baby and I'm sure in the future we should be able to treat this condition within the womb. Certainly operations for Spina Bifida now exist that do reduce the amount of Hydrocephalus in these babies.

MiddyStudent asks: Hi Doctor Kimber, in the case of Charlie with the lung problem, was the mother able to carry out a normal vaginal birth?

Chris Kimber: Yes in these conditions vaginal delivery is possible, as long as the balloon as been successfully retrieved. If the balloon is still inflated or there are complications with the balloon, there is a special C-section that can be performed where they gain control of the child's air way before they cut the cord. So there are some special techniques that may be required.

caitlin asks: I'm a 4th year medical student hoping to eventually specialise in neonatology - do you think this will be a commonplace procedure in future?

Chris Kimber: The indication for operations in the womb are increasing and so I suspect in 10 years time, as our equipment becomes smaller, and the ability to detect problems becomes easier, then the number of operations should increase.

sharz asks: We lost Samara at 6 days old (my first grand daughter), she had a dysplastic heart valve, could it be operated on in the womb or is this still too delicate and complicated?

Chris Kimber: There are some heart conditions where a catheter can be introduced into the heart and some surgeries can be performed, so in the future we are likely to see more of this.

RBBT asks: Do you do any operations in regards to Spina Bifida?

Chris Kimber: No, at the moment these operations are only performed at 1 or 2 places in the USA.

ingrid asks: Are you operation for Congenital Diaphragmatic Hernia CDH in utero here in Australia? If so, where? Is it safe for mum? Have many been performed here in Australia for CDH? And if so, with how much success?

Chris Kimber: There has been 2 cases done in Australia with the assistance of international experts. But typically with CDH, it's choosing the right foetus to operate on and we still remain uncertain as to which babies would really benefit from this sort of treatment. It is likely more of these will be done in the future because the success rates from large centres like London is beginning to demonstrate that this technique is very effective.

Robbie asks: When did prenatal surgery first occur in Australia?

Chris Kimber: We think the first open foetus operation was in 1990, 20 years ago, and Foetoscopy surgery has been around in Australia for 15 years.

Mark asks: How much additional training is involved to be able to do these procedures?

Chris Kimber: It's very difficult to get training, but many people will develop a research interest in this area for several years and then work in a large team for several years before they gain enough expertise. But it takes a long time to gain that sort of experience.

Matthew asks: Is there a chance of infection for the baby because of intrusion into the uterus?

Chris Kimber: Absolutely! We use antibiotics during the procedure to reduce the chances of that happening.

Matt asks: Do you find an operation in the womb to be more difficult or stressful than on a newly born child?

Chris Kimber: I think some operations on new born babies are very stressful, but when you operate in the womb, there are much greater difficulties, including the fluid around the baby is not always clear and so vision can be difficult. Also there is a problem of the baby floating and moving constantly throughout the operation, so there are many technical aspect from operating in the womb that make it a very complex procedure.

sharz asks: I just find it remarkable that you are able to assist life in this way, to loose a child is so heart breaking at a time which should be one of the happiest moments of your life. How do you feel when you are about to embark on a procedure that may be for the first time with no success history behind you?

Chris Kimber: I think that we are always caution and nervous about any new procedure, but we believe we've developed enough experience that we can operate within the womb quietly safely now. I think decade ago we were very concerned and nervous, but now we regularly access the womb and perform a number of surgeries and are much more confident to with the results even if we haven't done that exact particular surgery before.

emma71 asks: I had interuterine surgery 18 years ago at Melbourne Women’s Hospital my baby was diagnosed with a fluid build up in her plueral space and a shunt was introduced in her chest to drain this fluid I am happy to report the surgery was a huge success and my beautiful baby girl is now 18 and healthy :)

Chris Kimber: Congratulations! There are many children who've required shunts for a variety of conditions, and although they are risky, if they work the results are impressive as witness in your daughter.

katsta asks: Could surgery be possible to fix placental issues where cord flow to a baby is restricted?

Chris Kimber: In the case of twin pregnancy, where one twin has abnormal cord flow, then laser surgery is possible. But it is very difficult to do this when there is a single foetus present.

sharz asks: What has been the success rate in the 15 years in Australia for prenatal operations?

Chris Kimber: The success rate has changed during that time, whilst foetus survival was very high 15-20 years ago, now because the instruments are much smaller and because their techniques have improved, the survival rate for foetuses is certainly greater than 80%.

ingrid asks: Thanks Dr Kimber. How did the 2 CDH cases go here in Australia? Where were they performed? On what premise would you decide whether a baby with CDH would benefit with this treatment. My son was in the moderate range. He almost survived and made it to surgery etc.

Chris Kimber: My understanding was that both cases were performed in QLD, and I cannot tell you the outcome of those cases because I haven't heard the result. But the moderate range is a very difficult spectrum, but once a baby is born with moderate range, the survival rate is well above 90%. So we've been very cautious about offering the operation particularly to babies within the moderate range.

Cameron_G asks: How long is (average) recovery after prenatal surgery?

Chris Kimber: The mother often feels very good the next day and recovery is usually rapid because of the very small incision and instruments we use. However there is a risk of going into labour prematurely, and so we are very cautious about these women resuming excessive activity.

vib86 asks: Are there any chances of long term affects as a result of surgery while in the womb?

Chris Kimber: There are lots of long term risks from this type of surgery. The surgery itself is risky and can harm both the mother and foetus. That's why we are very cautious about offering any intervention unless we can see that there will be a real benefit and be able to give the baby a chance to live a normal life. There are many risk with these types of surgery and it can still even be dangerous for the child after birth. Many children who were offered the CDH technique have weak windpipes and have had complications following their delivery.

Nick asks: Is there a risk on damage to the placenta during the surgery?

Chris Kimber: Yes, and this risk is based on where the placenta sits within the womb. If the placenta is sitting within the front through where you would normally do the operation, the risk of separating it from the womb during the surgery is high and that does concern us.

Flutters asks: Dr Kimber, where do you see this kind of surgery going in the future? Do you think there will be more types of operations able to be performed ?

Chris Kimber: Yes, I think that with the development of robotic technology and improvement of imaging the foetus with different types of scans, that we would be able to pick up a larger range of conditions earlier and offer much less risky interventions for conditions that we could not otherwise treat at this point in time.

Interviewer: I am sorry we have come to the end of our questions, do you have anything else you would like to share before we finish tonight?

Chris Kimber: Thank you everyone for coming to speak with me tonight, I hope I was able to answer all your questions. Night!

Interviewer: Once again thank you and goodnight.

Interviewer: This concludes our chat with Chris Kimber, Sunday July 17, 2011.

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