Fetoscopic Laser Therapy for Twin-Twin

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Oct 15, 2013 - revealed that fetoscopic laser photocoagulation achieved bet- ter outcomes than ... (selective laser photocoagulation of communicating vessels.
Curr Obstet Gynecol Rep (2013) 2:257–261 DOI 10.1007/s13669-013-0062-7

HIGH-RISK GESTATION AND PRENATAL MEDICINE (T-F CHAN)

Fetoscopic Laser Therapy for Twin-Twin Transfusion Syndrome Yao-Lung Chang & Shuenn-Dyh Chang

Published online: 15 October 2013 # Springer Science+Business Media New York 2013

Abstract Ever since the first randomized, controlled trial revealed that fetoscopic laser photocoagulation achieved better outcomes than serial amnio-drainage for all stages of twintwin transfusion syndrome (TTTS) before 26 weeks, many centers have launched their fetoscopic laser therapy program for TTTS. Initially the nonselective method of laser therapy was applied, using the dividing membrane as a landmark to coagulate the placenta vessels, but currently selective methods (selective laser photocoagulation of communicating vessels (SLPCV), sequential SLPCV, and Solomon technique) have evolved to become the mainstream laser treatment modalities. Nevertheless, the nonselective method still has a role in difficult operations. Over the years, with regard to the prognoses of TTTS treated by laser, the attention has gradually shifted from survival rate to the neurological outcomes. The incidence of severe neurodevelopmetal delay remains considerably high in survivors of TTTS treated by FLP, which some reports cited ranging from 6 % to 18 %; learning curve effect exists, affecting both the survival rate and neurological outcomes of TTTS treated by laser. Because more, yet smaller and less-experienced, centers are being set up worldwide, the purpose of this manuscript is to review the basic knowledge and update information about the laser therapy for TTTS. Y.