Photo by Caitlin Abrams
Dr. Brad Feltis, Amina and Rania
While in utero, Amina and Rania Abdi received life-saving surgery from Dr. Brad Feltis (pictured) and his team.
At 16 weeks, a fetus is about the size of a lemon, and has veins much smaller than hairs, but she is not too small for surgery. That is, with a few conditions: You must have a laser as thin as a dime, a camera not much thicker than a dime, and a three-millimeter incision cut into mom’s belly to fit that laser and camera. You’ll also need a fetal surgeon who knows how to use all this technology, as well as a state-of-the-art surgical center with more screens than a sports bar so a support staff can keep an eye on the microscopic laser and the microscopic camera. Then, and only then, is a lemon-sized fetus not too small for surgery.
Siman Abdi was confronted with this surprising scenario one very bad day two-and-a-half years ago. “When someone explains it to you in theory, it sounds made up,” Abdi tells me at the brand new Michael and Ann Cirisi Midwest Fetal Care Center at the Mother Baby Center at Children's Minnesota and Abbot Northwestern. “It was all very science fiction.” Abdi had come to the fetal care clinic because she was pregnant with twins and feeling very sick. When her ultrasound dragged on and on, Abdi knew something was wrong. And when Dr. Brad Feltis, one of the chief and founding surgeons of the fetal care group, showed up, she thought, “Oh, this is not good.”
Feltis explained that her twins were in grave, immediate danger. They had something called Twin to Twin Transfusion Syndrome, in which the blood vessels of identical twins are connected, usually with a dominant twin getting more blood flow than its weaker sibling. More than 90 percent of cases result in the death of one or both twins. Abdi’s tiny daughters needed surgery, and they needed it now.
Feltis, 51, is tall. Basketball tall. He played the sport as a kid growing up in the farm country of North Fargo. He wasn’t very bookish when he was young, more interested in fishing and hunting. But he was always good at biology and was the first in his family to graduate from college. He got through medical school at the University of Minnesota, but then feared he’d made a terrible mistake.
“So many adult conditions are chronic. The worried well—not for me,” says Feltis. So he decided to try trauma surgery. “This is the life for me!” he remembers thinking. Like fishing and hunting, he discovered, trauma surgery required total alertness, total presence, total focus. During his trauma surgery training, he did a rotation in pediatric surgery and had his eureka moment: “You get to cure someone. They’ll never have a problem again in their life.”
Thus began 17 years of surgical education in the few places where fetal surgery was being pioneered, including Seattle, Belgium, and San Francisco. “There’s nothing else I know of where you can impact a life so positively,” says Feltis.
When he returned to the Twin Cities, he became Minnesota’s first fetal surgeon, starting a practice at Abbott with Dr. William Block. They named their operation the Midwest Fetal Care Center and launched it in 2008. At the time, it was basically a specialist’s office inside the hospital, using Abbott’s general operating rooms, but in March of this year they opened a new specialty fetal care clinic at Abbott, with fetus-focused state-of-the-art operating theaters and treatment rooms. Today, the group numbers a few dozen professionals—doctors, nurses, perinatologists, and geneticists—all dedicated to fetal care. It’s the first center of its kind in the five-state area.
Most people have never heard of the relatively new field of fetal surgery, but Feltis is sure that it will soon be everywhere—especially fetoscopic surgery, which is typically done with a tiny camera and tiny instruments guided through a tiny tube. Cleft palates, spina bifida (where the spinal cord develops outside of the spine), a wide array of anatomical deformities, tumors, hernias, twin-related conditions like TTTS—all of these will be treated by fetal surgery in the future, believes Feltis (sources at Abbott tell me that spina bifida repairs are being done there, but they won’t release details yet). “The fetal environment is incredible for healing,” says Feltis. “You’ll see no scarring, a kid who would have been in a wheelchair climbing around on a jungle gym.” At the Fetal Care Center, Feltis also operates on babies who are still getting oxygen from their mothers via the umbilical cord, through a sort of half-completed C-section. It’s a process Feltis uses if there’s a physical deformity blocking the airways. “That’s a kid who can fully recover,” says Feltis. “If it hadn’t been caught and treated, they’d never live.”
The demand for fetal surgery in Minnesota is already high. Before Feltis and company opened the state-of-the-art center, the group operated on some 900 pediatric patients a year. Feltis suspects they might soon be treating almost twice that number annually.
It’s complex care. Siman Abdi remembers watching her twins’ surgery on screens above her. “Every so often you’d see a hand float by, or a foot,” she remembers. “It felt like there were 100 people in the room.” That crowd included NICU teams for both babies, perinatologists, a fetal anesthesiologist, a maternal anesthesiologist, a neonatologist, a great many specialized nurses, and even an ethicist to help surgeons evaluate relative risks arising from complications or the discovery of additional birth defects.
Birth defects are more common than most people realize. We tend to group the most severe into broad categories that simply refer to the outcome, like stillbirth, or miscarriage. One in 5,000 babies, for instance, is born with a condition called omphalocele, in which the internal organs are not in the abdominal cavity, but outside the body in a sac formed from the umbilical cord. And instead of a belly button, there’s a large hole.
Robin and Kevin McGinnis were expecting a daughter, when they discovered she had omphalocele. Feltis operated on baby Ella just moments after she was born 19 months ago, carefully placing each and every organ where it ought to have been, connecting them together and in turn to all the necessary blood vessels.
“At first we were feeding Ella a milliliter at a time, to find out if there were any kinks or leaks,” remembers Robin. “We were so lucky. Dr. Feltis just happens to be the best surgeon in the world for this sort of thing. He made Ella a man-made belly button—he calls it the Feltis special. It looks like a real belly button. She’s a little girl, she’ll be able to wear a bikini. That’s not a big deal of course, but there are no scars. She eats anything. She’s talking. She’s completely normal.” The McGinnises moved to Boston recently. “We had a girls’ night the other night, in my little community,” Robin tells me. “People know Ella as this little thing zipping around the splashpark. I ended up pulling up a picture of Ella when she was in the NICU—no one could believe it.”
Abdi’s daughters are also thriving today. Such success stories are best case scenarios, but with some surgeries, Feltis faces a 50-50 chance of the fetus dying. That’s certainly better than a 100 percent chance of death without the intervention, but still.
Both Abdi and Robin say that they couldn’t do what Feltis does, knowing the downside. How does he handle such routine catastrophe? “I look at the hope,” Feltis says. “We see hope for a lot of pregnancies where other people see none. We think a lot of patients are being misled about the survivability of babies, often because people don’t know what’s possible today. And catastrophe—if you’re a surgeon and you haven’t experienced catastrophe, wait for it.”
As for what he himself considers catastrophic, Feltis tells me it was the time he took his five kids camping in the Boundary Waters and thunderstorms came rolling in, one after the other. “My 11-year-old looks at me and wails, ‘Daddy, why did you bring us here?’”
When they finally caught some fish, Feltis says he couldn’t shake the feeling that his fishing hooks, pliers, and knife were obscenely large and clumsy compared to the state-of-the-art surgical tools he was used to working with.
He prefers surgery to fishing, now. As it turns out, a fetus as small as a lemon is not too small for surgery, nor is she too small to change the life of a very tall and pioneering fetal surgeon.