Doctors in Miami save baby with unprecedented in utero surgery

 

Almost two years after Miami doctors successfully removed an oral tumor from Leyna Gonzalez -- while she was still in her mother’s womb -- the child is a healthy toddler with two very relieved parents.

dguzman@miamiherald.com

Leyna Gonzalez, now 20 months old, is a healthy little girl. On Thursday , her parents watched in awe as the toddler scurried down the hall at Jackson Memorial Hospital to give a tiny high five to one of the doctors who saved her life — before she was born.

While Leyna was still in her mother’s womb, fetal surgeons working for the University of Miami/Jackson Memorial removed a peach-sized tumor from her mouth in a procedure that was the first of its kind. Tammy and Alain Gonzalez spoke about their miracle daughter Thursday morning at the hospital where she was born almost two years ago.

Doctors Ruben Quintero and Eftichia Kontopoulos accompanied the family, explaining how the teratoma, a benign but rare growth, was safely detached in a breakthrough moment for in utero medicine.

“This baby was already kicking at 17 weeks,” said mother Tammy Gonzalez, who was almost at the midway point in her second pregnancy when the tumor was discovered during a routine ultrasound. The image showed the tumor like a bubble coming out of the fetus’ mouth.

“I was like, ‘there has to be a way to save her.’”

The mother’s gynecologist, Jason James, outlined the options: terminating the pregnancy, waiting the full term and risking a miscarriage — or a third possibility, a surgery had never been done before. James referred the worried parents to Quintero, who specializes in fetal surgery.

The condition is rare, Quintero said. Only one out of 100,000 babies develops a teratoma growth, but it can happen when just one cell multiplies uncontrollably. Quintero is known for his groundbreaking work in treating birth defects before infants are born, but he had never done a surgery to remove such a tumor in utero. He told the parents there were risks. It not be possible to remove the mass or a puncture could cause infection.

The Gonzalezes were hopeful, but still concerned about their daughter’s future.

“I said, let’s give it a chance,” Tammy Gonzalez said. She was awake for the entire procedure as doctors Quintero and Kontopoulos operated. An endoscope was inserted through her abdomen, guided by ultrasound, in order to visually capture the tumor. She was under local anesthesia, watching the monitor as the mass was detached by a laser from her daughter’s mouth.

“It was like this huge weight had been lifted off of me, and I could finally see her face,” she said. “It was perfect.”

Alain Gonzalez waited with Leyna’s now 7-year-old brother, A.J., just outside the operating room. When A.J. found out his little sister was healthy again, his father said excitement replaced the fear and anxiety they had felt for weeks.

“When we saw that she was fine, we couldn’t believe it,” Alain Gonzalez said.

About five months later, Leyna was born on Oct.1, 2010, at 8 pounds, 1 ounce. The only remnant of her early surgery is a small scar on her mouth, barely noticeable nearly two years later.

The case was recently published in the American Journal of Obstetrics and Gynecology. Quintero designed some of the surgical instruments used in the operation.

“No one had tried this before, but now it gives hope to other patients who could have the same problem,” he said.

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