Experience with fetoscopic cord ligation

Deprest, Jan; Ballaer, PP Van; Evrard, VA; Peers, K. H. E.; Spitz, Bernard; Steegers, E.A.P.; Vandenberghe, Kamiel

doi:10.1016/s0301-2115(98)00181-x

Cited by 103 publications

(43 citation statements)

References 25 publications

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“…Numerous treatment options for TTTS have been reported, including amnioreduction (AR) [6][7][8][9][10][11][12] , intertwin septostomy [13][14][15][16] , non-selective fetoscopic laser [17][18][19][20] selective fetoscopic laser photocoagulation (SFLP) [21][22][23][24][25][26][27][28] , and cord coagulation [29][30][31][32] , all of which have improved survival rates compared to the untreated natural history of TTTS. It has been controversial which of these treatment options would provide the best outcome in specific cases of TTTS.…”

Section: Introductionmentioning

confidence: 99%

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

Crombleholme

Shera

Lee

et al. 2007

American Journal of Obstetrics and Gynecology

158

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Objective-To examine the effect of selective fetoscopic laser photocoagulation (SFLP) versus serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).Study Design-5-year multicenter prospective randomized controlled trial. The primary outcome variable was 30-day postnatal survival of donors and recipients.Results-There is no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11/20) vs 55% (11/20) (p=1, OR=1, 95%CI=0.242 to 4.14) or Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 35% (7/20) (p=0.25, OR=5.31, 95%CI=1.19 to 27.6). This is offset by increased recipient neonatal mortality of 30% (6/20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (p=0.055, OR=3.025/point) by logistic regression analysis. NIH Public AccessConclusions-The outcome of the trial does not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.

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Section: Introductionmentioning

confidence: 99%

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

Crombleholme

Shera

Lee

et al. 2007

American Journal of Obstetrics and Gynecology

158

View full text Add to dashboard Cite

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“…In Europe, the Leuven team did the same a few months later, each group working in ignorance of the others' work . Upon compilation of all experience with fetoscopic cord ligation, the Preterm Prelabour Rupture of the Membranes (PPROM) rate of this procedure proved to be high and post-operative occurrence of amniotic bands was reported as well (Deprest et al, , 1998a. In 2000, Deprest et al (2000) described the use of a 3.0 mm, and later a 2.3 mm, bipolar forceps.…”

Section: Myelomeningocoele and Other Open Fetal Surgical Proceduresmentioning

confidence: 99%

The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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“…Ligation of the umbilical cord achieves an immediate and complete cord occlusion but is a cumbersome and lengthy procedure. 33 It has become replaced by cord or intrafetal thermocoagulation. Different thermal energy sources can be used, such as laser that can be applied by embryo fetoscopy or interstitially.…”

Section: Specific Instruments Used In Particular Indicationsmentioning

confidence: 99%

Instrumental requirements for minimal invasive fetal surgery

Klaritsch

Albert

Mieghem

et al. 2008

BJOG

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Minimal invasive intrauterine interventions have gained their place in fetal medicine. Interventions on the placenta, umbilical cord, fetal membranes or on the fetus require special endoscopes with their respective sheaths, cannulas and additional instruments. Instruments for fetal therapy are purpose designed for the procedure of interest and most gynaecologists are therefore not familiar with them. We review the currently available instrumentation used during operations for complicated monochorionic multiple pregnancies, congenital diaphragmatic hernia, amniotic band syndrome, urinary tract obstruction and hydrothorax.

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Experience with fetoscopic cord ligation

Cited by 103 publications

References 25 publications

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

The making of fetal surgery

Instrumental requirements for minimal invasive fetal surgery

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