[MUSIC PLAYING]
- [NARRATOR] It's the morning of the fetal surgery, the first surgery
of its kind to apply stem cells to the spinal cord
of a developing baby with spina bifida.
The first patient in this trial, known as the CuRe Trial,
is Emily from Austin, Texas.
She has traveled to California for the procedure.
Emily goes under anesthesia while the team monitors
her fetus via ultrasound.
Pediatric and fetal surgeon, Shin Hirose,
oversees the team.
They make the first cut.
- We open mom's abdomen
and we, generally, pull the uterus up and out of her belly.
So we open the uterus and then we identify
where the baby is sitting.
And we don't pull the baby all the way out.
We just sort of float the baby up to that incision
and we expose just the part that we need,
which is the myelomeningocele.
- [NARRATOR] The myelomeningocele is the spina bifida defect, an exposed
sac containing the damaged spinal cord and nerves.
Because the fetus is so tiny at 26 weeks gestation,
the neurosurgeons use a microscope
to perform their meticulous work on the spinal cord.
With the surgery underway, it's time for the stem cells
to make their trip across campus.
UC Davis scientist Priya Kumar and her team
transport the patches that contain the stem
cells to the hospital.
She slept in her office last night
so she could keep a close watch over the cells.
As the patches go on their journey,
Kumar is thinking about her journey that brought her here.
- Walking that corridor, carrying the bag
was when my emotions started running through
in my mind of the whole process of being a scientist.
- [NARRATOR] The bags get handed off to the surgery team.
- Nice job ladies. [APPLAUSE]
- [NARRATOR] And the lab team can finally get some rest
and will watch the procedure from another room
in the hospital.
The patches are carefully brought to the operating room.
- Cells are arriving.
- [NARRATOR] One bag of patches is set aside as backup.
The other is opened.
It contains two patches.
Only one of them is needed but both are prepared just in case.
The surgeons have exposed the defect
in the fetus's tiny back.
After years of research, the big moment
for applying the stem cell patch has finally arrived.
- Cell side up.
Right up.
- [NARRATOR] With great precision, Dr. Hirose brings the patch
to its final destination.
- Since the stem cells are on that patch,
we need to place that directly on the exposed spinal cord
and the myelomeningocele and then sew that to the dura
or the covering of the spinal cord
and then close the skin over that,
creating a watertight closure
and leaving those stem cells directly
on the exposed spinal cord.
- [NARRATOR] It's the first time this has ever
been done on a human fetus.
A first in medical history.
- I remember remarking just at the moment like,
Can you believe this is what we get to do?
Can you believe that this is the kind of thing
that we can do to help people?
Can you believe that it's taken so long to get here?
And we've been doing this for so many years
and finally we're able to put stem cells in a fetus.
It's just really an extraordinarily lucky feeling.
It really is.
- [NARRATOR] The surgical team stitches up Emily with great care
and attention to detail.
The procedure went exactly as planned.
- It was wonderful that it was very boring.
We want it to be boring.
Excitement in the operating room is usually
because something is going sideways.
- It was almost anticlimactic.
It was perfect and perfectly smooth.
It was just fantastic.
- [NARRATOR] This first of its kind surgery is complete.
- Wow, so thanks everybody.
- We did it.
- Done.
[APPLAUSE]
- [NARRATOR] Now the countdown to delivery begins.
Emily undergoes regular ultrasounds
so the team can monitor the baby's progress.
[HEARTBEAT SOUND]
The team discovers a complication,
one that's unrelated to the stem cells
but known to happen with fetal surgery.
- Her amniotic fluid levels remained low
and so we couldn't send her home.
- [NARRATOR] Too little amniotic fluid, the fluid
that cushions and protects the fetus
and is essential for its growth and development.
Instead of living at the apartment
she's rented in downtown Sacramento,
Emily's new home, for the foreseeable future,
is this hospital room.
- It's challenging, not impossible.
So we've done what we can.
My husband picked out this little quilt.
So we have our own bedding and that feels nice, of course.
But I think it's just bringing your very simplest comforts
and just items that may seem frivolous
but do make a pretty huge difference.
[SEWING MACHINE]
She passes the time by sewing costumes for her dance class
back at home and visiting with family and the CuRe Trial team.
- They stop by multiple times a week.
It feels like we've got kind of like a little home base
kind of check in every week.
- A lot of those visits were really just
to make sure that the fluid wasn't getting worse
or that she wasn't having any bleeding or any problems
with the fetus.
And we're doing twice a day ultrasounds
looking at the baby, making sure that she was OK.
- [NARRATOR] Around 30 weeks gestation, Robbie
provides some excitement.
While fetuses with her degree of spina bifida
typically have no leg movement, Robbie is kicking.
- The ultrasounds suggest that there
is more leg movement in the fetus
than they would have expected, given her level of lesion,
which is pretty high.
And Emily herself is describing what she says
is lots of kicking.
Now again, I'm trying to manage her expectations too.
But we are pretty excited.
- [NARRATOR] Emily also is cautiously optimistic.
- I feel like it's pretty easy to try and rely on the facts
and know that we're doing very well overall.
And that keeps me feeling pretty good, pretty optimistic.
But of course, there are a ton of unknowns.
- [NARRATOR] With each passing week, Emily and her family
celebrate that Robbie is staying put and growing.
They call it, "Happy NOT birthday."
A weekly celebration that Robbie has not
arrived ahead of schedule.
She makes it to the goal of 35 weeks.
Robbie is ready to make her debut.
By now, Emily has lived in the hospital
for more than two months.
With just days to go, she's feeling nervous, excited,
and just a little amazed to be making medical history.
- It's larger than life.
It's enhancing quality of life for so many patients to come.
It really blows my mind and it's hard to understand
just what it means and just how special
it is that we got to be part of this.
- [NARRATOR] Up next, delivery day for the first baby
in this groundbreaking trial.
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