Laser for twin-to-twin transfusion syndrome: a guide for endoscopic surgeons.
Fetoscopy
Laser
TOPS
TTTS
monochorionic twin pregnancy
twin twin transfusion
Journal
Facts, views & vision in ObGyn
ISSN: 2032-0418
Titre abrégé: Facts Views Vis Obgyn
Pays: Belgium
ID NLM: 101578773
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
entrez:
22
2
2020
pubmed:
23
2
2020
medline:
23
2
2020
Statut:
ppublish
Résumé
Twin-to-twin-transfusion syndrome (TTTS) is the most important cause of handicap and death in monochorionic twin pregnancies. It is caused by a certain pattern of anastomoses between the two fetal circulations leading to an unbalanced blood and fluid transfer. This leads to severe amniotic fluid discordance and variable degrees of cardiac dysfunction. Untreated, this condition has a very poor survival rate. Fetoscopic laser has been shown to be the best first line treatment, which aims to dichorionise the placenta therefore arresting the inter-twin transfusion. Fetoscopic laser is a causative therapy, which aims to functionally create a dichorionized placenta hence arresting inter-twin transfusion. This is achieved by percutaneous sono-endoscopic coagulation of placental anastomoses. In addition, redundant amniotic fluid is drained. Fetoscopic laser coagulation of chorionic plate anastomoses is safe and effective. There is level I evidence that it is the best treatment modality, in particular when the placental surface is lined along the vascular equator. A recent meta-analysis confirmed an increased fetal survival and decreased risk for neonatal and pediatric neurologic morbidity. Laser therapy is the first line therapy for TTTS. The technique is quite standardized and safe and effective in experienced hands. Herein we describe the technique and current instrumentation used for this procedure.
Types de publication
Journal Article
Langues
eng
Pagination
197-205Informations de copyright
Copyright © 2019 Facts, Views & Vision.
Déclaration de conflit d'intérêts
JD is partly funded by the Great Ormond Street Hospital Charity Fund. LVDV and JvdM is supported by the Erasmus+ Programme of the European Commission (2013-0040). LL is funded by the FWO (Fonds voor Wetenschappelijk Onderzoek) (1804718N). Our research on novel instrumentation in fetal surgery is supported by an Innovative Engineering for Health award by the Wellcome Trust (WT101957) and the Engineering and Physical Sciences Research Council (ESPRC) (NS/A000027/1).
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