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Table 1 Summary of the EXIT surgical technique in our Department

From: Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

EXIT DESCRIPTION
1. Personnel: Multidisciplinary team including anesthesiologists, pediatric surgeons, neonatologists, maternal-fetal medicine specialists, and operating room nurses.
2. Maternal anesthesia: Deep general anesthesia is used, in addition, an epidural catheter is placed to facilitate postoperative pain management of the mother. General anesthesia induction (remifentanil, propofol and rocuronium) is followed in rapid sequence by intubation and assisted ventilation. Before the uterine incision, deep inhalational anesthesia with sevoflurane is used to maintain uterine relaxation and preserve uteroplacental circulation and fetal gas exchange.
3. Access to the uterine cavity:
 a. Low transverse laparotomy.
 b. Once the uterus is exposed, intraoperative sterile ultrasonography is used to
 c. map, carefully, the position of placenta and fetus.
 d. The location of the hysterotomy is determined by the placental locations, and a margin of at least 5 cm from the lower placental edge is left.
 e. Uterine progressive distractor, Satinsky vascular clamps, and a stapling device (Premium Poly Cs-57 Autosuture®) are used in this order to enter into the amniotic sac with minimum uterine bleeding (Fig. 1).
 f. Amnioinfusion with Rintgen’s solution is performed to keep uterine volume.
4. Fetal exposure: A gentle fetal extraction with the help of a single-use suction vacuum (Kiwi©) is performed and the fetus is exposed to the shoulders.
5. Fetal airway management: Fetal anesthesia is supplemented by an intramuscular shot (fentanyl, vecuronium, and atropine) immediately after fetal exposure. Then, the fetal head is positioned to allow access to the airway by direct laryngoscopy or bronchoscopy.
6. Delivery: Once the fetal airway management is completed and secured, the umbilical cord is clamped and divided. The placenta is delivered, the uterine tone is restored (carbetocin plus oxytocin). Finally, uterus and maternal abdominal wall are closed similar to a cesarean section.