Fetoscopic Nd:YAG laser coagulation for twin-twin transfusion syndrome in cases of anterior placenta

Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin‐twin transfusion syndrome: a single center study

“…A distribution plot of the laser time showed no evidence of a skewed pattern. The number of anastomoses ablated was not significantly different between the three groups [7 (5-12) in SAP vs 6 (5-11) in LAP and 8 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) in SPP, p = 0.47]. There were no significant differences seen between the three groups in terms of the amount of fluid either removed or infused during the case.…”

“…1 An anterior placenta is found in approximately 45% of patients with a monochorionic twin pregnancy who present with TTTS in the second trimester. [2][3][4] Ultrasound-directed percutaneous fetoscopic laser photocoagulation of placental anastomoses has become the standard treatment for TTTS diagnosed before 26 weeks of gestation. [5][6][7] The same percutaneous technique has traditionally been used in cases of both anterior and posterior placentation.…”

Twin–twin transfusion and laser therapy

“…The first laser treatments were performed using laparotomies to gain access to the uterus with entry into the uterus with the fetoscope [24]. From there, multiple authors have published their techniques on gaining access to the intraamniotic environment through laparoscopic incisions [25][26][27][28][29]. One of the most challenging aspects in the technique of fetoscopic laser treatment in TTTS is the location of the placenta.…”

“…In theory, the surgeon would need to enter the back wall of the uterus to best visualize the fetal surface of the anterior placenta. Initial surgical techniques for anterior placentas used combinations of laparotomy and laparoscopic entries with success [26,27], albeit with significant surgical risk. However, it is now possible with good surgical technique to visualize the anterior placenta without the use of additional surgical entry procedures.…”

Letter to the Editor Concerning the Article by Sohn C et al. Fetal Diagn Ther 1996; 11:390-397 Laser-Induced Thermotherapy for Severe Twin-Twin Transfusion Syndrome

“…The interstitial laser-induced thermotherapy (LITT) technique makes it theoretically pos sible to obliterate deeply located anasto moses, which are believed to be responsible for symptomatic TTS [2]. It also deals with anteriorly located placentas, which some be lieve to be more difficult to coagulate through the fetoscope, an optimal angle of coagulation being difficult to achieve [3]. Furthermore, the use of power Doppler imaging (PD1) is described to be useful for identifying anastomosing vessels, as re ported earlier by Hecher et al [4,5] using colour and pulsed Doppler.…”