In Utero Surgery – More Common Today, But No Less Miraculous

You might recall a particular photograph that caused quite a stir back in 1999. It was the photograph of Samuel Armas, then just a 21-week-old fetus, reaching his tiny hand out from inside the uterus to clasp onto the doctor’s finger during a surgical procedure to correct the birth defect spina bifida. The fetal surgery at the time was still a bold undertaking, just two years after the first of its kind in 1997. Today, 13 years after Samuel’s “Hand of Hope,” the amazing procedure has been performed on over 400 fetuses around the world.

"The Hand of Hope"

Spina bifida affects 1,500 births per year, making it the most common birth defect.  The most dangerous form of spina bifida, called myelomeningocele, is a condition in which the spinal cord does not close properly and remains exposed. Ten percent of babies born with untreated myelomeningocele die, and those that survive will have severe disabilities such as paralysis and bowel and bladder dysfunction.

But as the fetal surgery is performed in increasing numbers the outlook improves for a fetus diagnosed with spina bifida.

Famous before he was born, 21-week-old Samuel Armas' hand reached out during surgery. In utero surgies have now been performed since 1997.

The procedure begins by putting the mother under deep general anesthesia. That way not only does the mother go under but the fetus as well. In addition, the uterus relaxes which makes it easier to work with. An ultrasound is performed to get the exact position of the fetus, then an incision is made clear across from hipbone to hipbone. The surgery is then performed with the fetus still inside the uterus. Absorbable staples are used to pinch uterine blood vessels to minimize bleeding, and more staples are used to keep the uterine membrane out of the way. The spinal cord repair is the same procedure that doctors would perform on a newborn baby. It involves placing the nerve tissue back into the spinal canal and closing it up with a layer of dura, the tissue that normally covers the spinal cord and brain, a layer of muscle-like tissue, and lastly a layer of skin. The closure has to be watertight. One reason is to protect against damage from amniotic fluid seeping in, another is to prevent the leakage of cerebrospinal fluid. The decreased fluid volume leads to the hindbrain herniation and hydrocephalus associated with spina bifida. If the procedure is done early enough – ideally around 20 weeks – those abnormalities can be reversed.

When the surgeon was finished operating on Samuel in December, 1999, the photographer covering the surgery happened to look over and see a very small hand poking out through an opening in the uterus, seemingly holding onto the doctor’s finger. Quickly, he snapped the shot.

The photo appeared in USA Today on Sept. 7, 1999, and it truly was extraordinary. An almost choreographed, tender portrayal of an unborn child reaching out as if to say thank you to the doctor who just saved his life. The picture went viral on the Internet and was reprinted in news articles around the world, heralding it “The Hand of Hope.” Many people had a spiritual interpretation of the picture, including Armas himself. The then 9-year-old told Fox News in a 2009 interview, “When I see that picture, the first thing I think of is how special and lucky I am to have God use me that way.” Michael Clancy, the serendipitous photographer, was also deeply moved. The photo would be his last for a newspaper. After capturing what he called a “miracle moment,” Clancy gave up freelance photography. He now works as a motivational speaker at pro-life events.

But Dr. Joseph Bruner, the doctor who performed the surgery, wasn’t so moved. A month after the surgery Dr. Bruner told the Tennessean that it was he who reached out to Samuel, not the other way around. Noting that both mother and baby were heavily anesthetized and incapable of moving, he told reporters that he had pulled Samuel’s hand out of the uterus.

Regardless of whether you think it was Samuel, Dr. Bruner, or God who made the connection happen, we can all agree that operating on a fetus while it is still in the womb is a miracle of modern science.

[image credits:, Fox News, and CNN]
image 1: Hand of Hope
image 2: Samuel
image 3: Hand of Hope

Peter Murray
Peter Murray
Peter Murray was born in Boston in 1973. He earned a PhD in neuroscience at the University of Maryland, Baltimore studying gene expression in the neocortex. Following his dissertation work he spent three years as a post-doctoral fellow at the same university studying brain mechanisms of pain and motor control. He completed a collection of short stories in 2010 and has been writing for Singularity Hub since March 2011.
Don't miss a trend
Get Hub delivered to your inbox