The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation (original) (raw)
Related papers
The Open Medical Devices Journal, 2012
Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal treatment choice since the release of the Eurofetus randomized clinical trial. These techniques have been adopted throughout the globe, and many institutions have instituted or will soon institute fetoscopic laser surgery procedures; however, laser surgery has a steep learning curve because of the following: challenging placental location, complex and unexpected communicating anastomoses, residual anastomoses after surgery, or discolored amniotic fluid. We have been performing laser surgery since 2002 in Japan; to date, we have compiled a series of 170 cases. Our data indicates a 78% of overall survival with 5% neonatal morbidity, 63% of survival of both twins, and 93% survival of at least one twin. The recurrent TTTS rate was 1% and the residual vessel rate was 3%. To improve the learning curve of laser surgery, the employment of various techniques is recommended to achieve a successful surgical outcome: (1) Mapping: before laser ablation, a very thorough mapping of vascular anastomoses should be done, and should be repeated after ablation; (2) Sequential order: obliteration of arterio-venous anastomoses from donor to recipient should be done first to avoid donor hypotension and/or anemia; (3) Trocar (cannula) assisted technique: Trocar assisted technique: Using gentle indent the trocar to the placenta by withdrawing the scope shortly, then anastomoses could be ablated easily; (4) Line method: to avoid residual anastomoses, the laser should draw a virtual line at the hemodynamic equator; The operator must be careful not to miss small anastomoses. These techniques can help achieve a successful outcome for fetoscopic laser surgery and improve the outcome for cases of severe TTTS.
Obstetrics & gynecology science, 2018
To evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment of twin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. This prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18-26 weeks of gestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamniotic membrane were nonselectively photocoagulated. The χ test and Mann-Whitney test were used for the statistical analysis. The mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age at birth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1 g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followed by stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetus...
Mutidiode laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome
The Ultrasound Review of Obstetrics & Gynecology, 2006
Objective. To describe the outcome of monochorionic twin pregnancies complicated by twin-twin transfusion syndrome, managed in a single perinatal centre and treated with multidiode laser photocoagulation of abnormal placental communicating vessels. Material and Methods. From November 2002 to July 2004, 12 patients diagnosed with twin-twin transfusion syndrome were treated with multidiode laser photocoagulation (14 procedures). Monochorionic twin pregnancies with severe polyhydramnios in the recipient twin and strong oligohydramnios in donor twin is the key diagnostic feature in this syndrome; once diagnosed, severity of the syndrome was established following the classification reported by Quintero and cols. After laser therapy was completed we evaluated survival rates and complications associated with therapy. Results. Selective laser photocoagulation of communicating vessels was performed in 12 patients (14 procedures). In all these cases, both laser treatment and amnioreduction were carried out. The average number of abnormal placental communicating vessels was eight and average surgery time was 25 minutes. No maternal post-surgery complications were observed but there was a preterm premature rupture of membranes which most probably could be the cause of the subsequent miscarriage. Fetal survival rate of at least one twin to 28 days of age was 70%, while the number of deaths was associated to: 7 intrauterine deaths after surgical procedure, 2 neonatal deaths after preterm delivery and 2 deaths caused by a miscarriage after preterm rupture of membranes. Discussion. Twin-twin transfusion syndrome is a heterogeneous disorder in its clinical expression and progression. Laser photocoagulation is an efficient treatment for this syndrome, its spread and application in other centres would allow early management of this disorder, decreasing the fetus/neonatal morbidity and mortality rate. In this study we have applied a selective technique using a multidiode laser with results similar to those obtained in other studies that have been reported, which are survival rates between 50 to 76%.
Laser for the treatment of twin to twin transfusion syndrome
Acta Cirurgica Brasileira, 2005
PURPOSE: To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation. METHODS: Prospective study of eight cases diagnosed with TTTS evaluated in our service from january 2001 to june 2005. Through percutaneous introduction of a 2,0mm diameter fetoscope in the uterine cavity, placental surface vessels where directly visualized. Those identified as responsible for the transfusion were laser coagulated. The procedure combines ultrasonography and fetoscopy, in a so-called sonoendoscopic technique (FETENDO). RESULTS: Among the eight pregnancies evaluated, five cases were submitted to the procedure (10 fetuses). All fetuses survived for at least five weeks after surgery. A total of eight fetuses were born alive and five survived the neonatal period. In a 18 months follow-up after birth, all five are still alive and well and their mean age is now 10,6 months. The total survival rate was 50% and in three pregnancies, at least one fetus survived. CONCLUSIONS: Laser fetoscopy is actually the "gold-standard" treatment of TTTS. Nevertheless is a sophisticated technique that epends of proper training. Our service is the first in our country to offer this therapeutic technique. Our success rate is comparable with the international literature.
Fetoscopic laser treatment of twin-to-twintransfusion syndrome (TTTS)
PubMed, 2008
The aim of this study was to report the results of the first 10 cases of fetoscopic laser surgery for twin-to-twin transfusion syndrome by the Rotunda Hospital Fetal Treatment Programme. All cases of severe TTTS managed by our team from 2006 to 2007 were included. All fetoscopic laser surgeries were performed by a single specialist in fetal medicine. All pregnancies were followed up to pregnancy completion and a minimum of six weeks neonatal life. Laser surgeries were performed with ultrasound guidance and percutaneously using local anaesthesia via a 2.8mm rigid fetoscope. Selective laser ablation of placental vessels was accomplished with a neodymium:YAG laser. The first 10 cases of severe TTTS managed by our team are reported. Laser ablation of placental vessels was accomplished successfully in all cases. Two pregnancies were complicated by preterm premature rupture of membranes before 22 weeks and both pregnancies were lost. Of the remaining 16 fetuses, one was diagnosed with significant ventriculomegaly postoperatively and underwent selective termination in the United Kingdom. The overall intact neonatal survival rate was 65%. Fetoscopic laser ablation of placental vessels for severe twin-to-twin transfusion syndrome is now available in Ireland, and our programme has delivered results that are in keeping with international best practices in this regard.
Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks' gestation
American Journal of Obstetrics and Gynecology, 2013
The purpose of this study was to compare perinatal outcomes of pregnancies that undergo "early" (Ͻ17 weeks' gestation) or "late" (Ͼ26 weeks' gestation) fetoscopic laser ablation of placental vascular anastomoses for twin-twin transfusion syndrome (TTTS) with "conventional" cases that were treated at 17-26 weeks' gestation. STUDY DESIGN: We conducted a single center, retrospective analysis of 325 consecutive pregnancies that underwent fetoscopic laser therapy for severe TTTS. RESULTS: Twenty-four "early," 18 "late," and 283 "conventional" pregnancies with severe TTTS underwent laser therapy. Fetoscopy duration , gestation at delivery, survival rate, and complications were comparable among groups, except for preterm premature rupture of membranes at Ͻ7 days after laser therapy, which was more common in the "early" group than in either of the other 2 groups. CONCLUSION: Laser therapy for TTTS at Ͻ17 or Ͼ26 weeks' gestation has similar outcomes to procedures done at 17-26 weeks' gestation. We suggest that conventional gestational age guidelines of 16-26 weeks for laser therapy for TTTS should be reevaluated.
A worldwide survey of laser surgery for twin-twin transfusion syndrome
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2015
To evaluate differences between international fetal centers in their treatment of twin-twin transfusion syndrome (TTTS) by fetoscopic placental laser coagulation. Fetal therapy centers worldwide were sent a web-based questionnaire. Participants were identified through networks and through scientific presentations and papers. Questions included physician and center demographics, treatment criteria, operative technique and instrumentation. Laser treatment was compared between low-volume (< 20 procedures/year) and high-volume (≥ 20 procedures/year) centers. Data were analyzed using descriptive statistics. Of 106 fetal therapy specialists approached, 76 (72%) from 64 centers in 25 countries responded. Of these, 48% (31/64) of centers and 63% (48/76) of operators performed fewer than 20 laser procedures annually. Comparison of low- and high-volume centers showed differences in technique, gestational age limits for treatment and geography. High-volume centers more often used the Solomo...