Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?
Abstract:The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need … Show more
“…A multi‐center retrospective review reported the RFA UCO outcomes significantly differed between centers that had performed ≥6 cases and those that had performed ≤5 cases . Prior studies have suggested that the learning curve for selective laser photocoagulation of communicating vessels for TTTS stabilizes after 25 cases . This study compared the surgical outcomes from 2 different time frames.…”
Section: Discussionmentioning
confidence: 98%
“…16 Prior studies have suggested that the learning curve for selective laser photocoagulation of communicating vessels for TTTS stabilizes after 25 cases. 17,18 This study compared the surgical outcomes from 2 different time frames. Prior to the year 2014, the preferred method of UCO was via laser, while after 2014, the preferred method of UCO was RFA.…”
Despite clear technical advantages of RFA compared with laser, we found that RFA appeared to be associated with increased risk of post-procedure fetal demise. Further studies should be conducted to confirm these findings.
“…A multi‐center retrospective review reported the RFA UCO outcomes significantly differed between centers that had performed ≥6 cases and those that had performed ≤5 cases . Prior studies have suggested that the learning curve for selective laser photocoagulation of communicating vessels for TTTS stabilizes after 25 cases . This study compared the surgical outcomes from 2 different time frames.…”
Section: Discussionmentioning
confidence: 98%
“…16 Prior studies have suggested that the learning curve for selective laser photocoagulation of communicating vessels for TTTS stabilizes after 25 cases. 17,18 This study compared the surgical outcomes from 2 different time frames. Prior to the year 2014, the preferred method of UCO was via laser, while after 2014, the preferred method of UCO was RFA.…”
Despite clear technical advantages of RFA compared with laser, we found that RFA appeared to be associated with increased risk of post-procedure fetal demise. Further studies should be conducted to confirm these findings.
“…1 This procedure is technically complex with significant risks of fetal and/or maternal complications and universal provision continues to be challenging. 2 Surgical training with twin-twin simulators has been proposed in order to help centres meet these challenges. Recent publications have described TTTS simulators, both physical 3,4 and digital.…”
We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome � This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings
“…Examples for approaches that aim to achieve a prenatal cure include fetal blood transfusions for anemia [22] and fetoscopic laser dichorionization of the placenta in TTTS [39]. In addition to the appropriate care setting, the ability to achieve the intended outcome with these low-to medium-complexity therapies relies on operator experience and ongoing caseload [40][41][42][43][44]. Because the mortality of the underlying conditions in the absence of treatment is high, thresholds for the establishment of treatment centers are lower than for more complex treatments.…”
Section: The Scope and Goals Of Fetal Therapymentioning
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