Rambam: Rare Surgery Performed on Baby during Birth
When Sima Sanbeto learned that her unborn baby had a respiratory obstruction, she never expected that during the birthing process, it would undergo one of the rarest and most complex surgeries ever conducted at Rambam Health Care Campus. 27 May 2019 – More than twenty doctors, nurses and technicians crowded into the operating room to perform an extremely rare and complex surgery, even for a large regional hospital like Rambam Health Care Campus, where the staff are accustomed to complicated procedures. The surgery was performed on a baby with a defect that caused her airway to be blocked. As long as the baby was in her mother's womb, there was no problem since oxygen was delivered via the placenta. However, doctors feared that at the moment of birth, immediately after the placenta was removed, the baby would choke due to the blocked airway. “My pregnancy was normal,” says Sima Sanbeto, 31, a resident of Afula, Israel. “Two months before I was due to give birth, I had an MRI. The doctors told me that there was a problem with the baby's breathing, but they did not tell me at this stage that it might endanger her life, apparently so as not to worry me. I understood from what they said that the situation was serious.” According to Sanbeto, she was told that the birth would be difficult and that a complex operation would be required. “I heard the doctors and I cried. My partner, Meni, and my friends strengthened me and told me that everything would be all right. We had a difficult time before the birth and the operation,” recalls Meni, “as there was a very real concern that it would not end well.” On May 16, Sima was brought into the operating room. “I don’t remember anything from the birth. The surgery was performed under general anesthesia. Before they put me under, I was afraid that it wouldn’t work out. I was more concerned for my baby than for myself.” Rambam’s medical team performed a complex surgery, during which—like in a “normal” cesarean section—they removed only the baby's head from her mother's abdomen. While still receiving oxygen from the placenta, the doctors began to surgically open her airway. However, it soon became clear that the obstructed airway would require a longer time to repair than the time available to them, before the placenta would stop functioning as the baby’s primary oxygen supplier. The doctors performed an emergency tracheotomy (an airway directly into the trachea), confirmed the baby’s ability to breathe, and then completely removed her from her mother's womb. In order to carry out the complex task, simultaneous coordination of several multidisciplinary teams of doctors and nurses was needed – one anesthesia team for the mother and one for the infant, a team of oral and maxillofacial surgeons, a team of ear-nose and throat surgeons, midwives and obstetricians, and a neonatal intensive care unit (NICU) team. Meni, the baby's father, will never forget the time he spent sitting outside the operating room. “I was worried,” he said, “but the doctors came out to talk to me during the surgery and calmed me down.” Sima adds, “When I woke up after the surgery, I heard that everything went well and that my baby was okay. The doctors told me that they fought for her and didn’t give up, and they saved her. The baby is now recovering in Rambam’s NICU. The mother was discharged a few days after the birth, but both parents are staying at their daughter’s side for a few more weeks at Rambam until the necessary surgeries to repair her airway are completed. The couple is so thankful for Rambam's medical team. “It is fortunate that medicine can provide an answer to difficult cases such as ours and save lives,” said the happy mother, adding, “Thank you very much to all the doctors and nurses, for everything you did.”
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