Minimal-access fetal surgery for twin-to-twin transfusion syndrome

J. G. Bussey, F. Luks, S. R. Carr, M. Plevyak, T. F. Tracy

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Laser ablation of placental vessels effectively halts severe twin-to-twin transfusion syndrome (TTTS), but fetal surgery remains a dangerous approach. The authors present the technical aspects of endoscopic fetal surgery in their initial clinical experience. Methods: Altogether, 11 women underwent endoscopic fetal surgery for severe TTTS. Access to the recipient's sac was obtained by the Seldinger technique via minilaparotomy. A 12-Fr peel-away introducer was used as a cannula to accommodate a custom-curved 9-Fr sheath containing a 1.9-mm semirigid fiber endoscope. Laser ablation was performed on all unpaired vessels crossing the intertwin membrane using a 400-μm neodymium: yttrium-aluminum-garnet (Nd: YAG) fiber. The cannula was removed over a gelatin sponge plug. Results: The median operating time was 65 min (range, 45-105 min). No patient experienced amniotic leak postoperatively. The length of hospital stay was 2.8 ± 1.6 days. Immediate improvement of the TTTS was noted in all but two patients. Pneumonia developed, in one mother leading to premature labor. There were no other major surgical complications. Fetal survival at 2 weeks was 73%. Conclusions: The safety and efficacy of endoscopic fetal surgery for severe TTTS can be optimized with the application of current minimal-access techniques. The superiority of this approach over less invasive means is still being evaluated through prospective studies.

Original languageEnglish (US)
Pages (from-to)83-86
Number of pages4
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2004

All Science Journal Classification (ASJC) codes

  • Surgery

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