Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt, Marjolijn S.; Lopriore, Enrico; Steggerda, Sylke J.; Slaghekke, Femke; Klink, Jeanine M.M. van

doi:10.1080/17474086.2020.1720643

Cited by 20 publications

(31 citation statements)

References 96 publications

(113 reference statements)

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“…Fetoscopic laser surgery (FLS) is considered standard treatment for TTTS, involving coagulation of the placental vascular anastomoses between the donor and recipient twins 2 . Survival rates after FLS have increased over the years due to improvements in technique, with a dual survival rate of 71% and a rate of survival of at least one fetus of 88% 3 . Approximately two-thirds of TTTS cases are complicated by sFGR 4,5 , and these cases have a lower survival rate following FLS 6 .…”

Section: Introductionmentioning

confidence: 99%

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Donepudi

Espinoza

Nassr

et al. 2021

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Utilization of the Delphi contributory criteria for defining selective fetal growth restriction (sFGR) in pregnancies with twin-twin transfusion syndrome classifies more cases as having sFGR compared to other definitions. This definition also had the highest predictive value for donor twin demise following fetoscopic laser surgery for twin-twin transfusion syndrome. What are the clinical implications of this work?Standardization of the definition of sFGR should enable more consistent prediction of outcome. Not only does this influence our management decisions with regard to fetal surveillance, but it also enhances patient care and counseling, especially in cases requiring surgical management.

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Section: Introductionmentioning

confidence: 99%

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Donepudi

Espinoza

Nassr

et al. 2021

Ultrasound in Obstet & Gyne

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“…There is a growing need for steerable and flexible endoscopes to visualize and ablate anastomoses on anterior placentas. [4,52] To address this need, a robotic platform that enables precise and intuitive navigation of a magnetic fetoscope anywhere in the uterus is presented. We utilized a shared control strategy that combines teleoperation and visual servoing.…”

Section: Discussionmentioning

confidence: 99%

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Lussi

Gervasoni

Mattille

et al. 2022

Advanced Intelligent Systems

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In the past 40 years, the percentage of twin pregnancies has increased by almost a third as a result of a rise in medically assisted reproduction and delayed childbearing. [1] Of the 1.6 million twin pairs born around the globe every year, %15% are monochorionic (MC), i.e., they share the same placenta. [2] These pregnancies present more frequent complications than dichorionic twins that develop with separate placentas. [3] One of these complications arises from vascular anastomoses that connect the blood circulation systems of both fetuses to the placenta. Twin-to-twin transfusion syndrome (TTTS) affects 10-15% of MC multiple pregnancies and is characterized by a chronic, imbalanced blood flow from the donor to the recipient twin, which results in a disproportionate nutrient supply. [4] If left untreated, the consequences of TTTS are severe, leading to a mid-trimester mortality rate of up to 95%. [5] State-of-the-art treatment of TTTS involves fetoscopic laser coagulation of the placental anastomoses. Under ultrasound guidance, the surgeon identifies a safe entry site in the maternal abdomen from which a fetoscope is inserted through a trocar (typically 2.2-4 mm in diameter; 7-12 French [6] ) into the recipient's amniotic sac. The fetoscope consists of a camera and a working channel to deliver laser light through an optical fiber at the desired location. Before the surgeon ablates the vessels, the vascular architecture is scrutinized and the connecting vessels are identified. Subsequently, all identified anastomoses are coagulated with a neodymium-doped yttrium aluminum garnet (Nd:YAG) or diode laser such that the MC circulation is converted into two independent vascular systems. [7] To ensure no small vessels are missed, the laser is repeatedly fired along a line connecting all the coagulation points from one placental border to the other (known as the Solomon technique). [5,8,9] Mortality rates still range from 20% to 48% after this surgical procedure and significant complications are reported in 6-18% of surviving newborns. [10] Neurological damage to the fetus is also more likely to occur in technically difficult cases. [8] As the procedure is demanding, outcomes are also dependent on the surgeon experience. [7,10] Cases with anterior placentas (i.e., located on the abdominal side of the uterus) constitute a major challenge, even for experienced surgeons. Good access and visualization of anterior placentas are difficult with rigid endoscopes. [11] This can prevent complete coagulation, which,

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“…This potentially life-threatening condition occurs in 10-15% of MC twins, as well as in dichorionic triamniotic (DCTA) and monochorionic triamniotic (MCTA) triplets, in which the prevalence is currently unknown 6 . Hemodynamic alterations of the unequal vascular sharing might trigger a vicious cascade that could result in cerebral perfusion damage, cardiovascular compromise, in-utero demise and medically indicated preterm delivery 7 .…”

Section: Introductionmentioning

confidence: 99%

Perinatal outcomes of fetoscopic laser surgery for twin–twin transfusion syndrome in triplet pregnancy: cohort study, systematic review and meta‐analysis

Mustafa

Javinani

Krispin

et al. 2022

Ultrasound in Obstet & Gyne

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The rate of survival after fetoscopic laser photocoagulation in monochorionic triamniotic triplets is higher than that reported in previous studies and is currently comparable with the rate of survival in dichorionic triamniotic triplets, which could be due to improved surgical skills. What are the clinical implications of this work?This study provides pertinent clinical information that should be useful when counseling parents with a triplet pregnancy complicated by twin-twin transfusion syndrome about management with fetoscopic laser photocoagulation.

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Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Cited by 20 publications

References 96 publications

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Perinatal outcomes of fetoscopic laser surgery for twin–twin transfusion syndrome in triplet pregnancy: cohort study, systematic review and meta‐analysis

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