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

Abstract

Background The objective of our study was to compare outcomes following laparoscopically assisted procedure (LAP

Preoperative Ultrasound Prediction of Essential Landmarks for Successful Fetoscopic Laser Treatment of Twin-Twin Transfusion Syndrome

“…Amnioinfusion was not performed preoperatively in the two cases of recurrence due to associated short cervical length and we were able to achieve complete coagulation on the first attempt in the remainder of our cases that required transplacental entry. This further supports the integration of multiple preoperative ultrasound landmarks into a methodical evaluation for procedure planning and anticipation of the vascular equator's location without increasing the complexity of the surgical approach, maternal morbidity, and recovery, or the risk for preterm premature rupture of membranes as documented in the laparoscopic-assisted approach [24].…”

“…Additionally, anterior placental location may force selection of a suboptimal vantage point to avoid transplacental entry or septostomy. Alternative surgical approaches such as preoperative amnioinfusion, laparotomy with exteriorization of the uterus and laparoscopic-assisted fetoscopy have been utilized to avoid transplacental entry in cases of complete anterior placenta to avoid this issue [23,24]. Amnioinfusion was not performed preoperatively in the two cases of recurrence due to associated short cervical length and we were able to achieve complete coagulation on the first attempt in the remainder of our cases that required transplacental entry.…”

Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature

“…Under direct laparoscope visualization, a second port was placed and used to elevate the uterus to allow the lateral side of the uterus to be exposed for insertion of the fetoscope. As we have described before, 14 a 2.0 mm 0-degree fetoscope (11630AA, Karl Storz, Tuttlingen, Germany) was used.…”

Perioperative Care of Patients Diagnosed With Twin‐to‐Twin Transfusion Syndrome Undergoing Laparoscopic‐Assisted Fetoscopic Placental Laser Photocoagulation

“…When treatment is necessary, fetoscopic placental laser photocoagulation (FPLP) is the procedure of choice to ablate connecting vessels between the twins and provide each fetus with independent blood flow 3 . In many cases, the surgeons can complete the procedure through a small incision in the abdomen and use 10‐ or 12‐Fr cannulas as laparoscopic ports to provide percutaneous access to the uterine cavity 4 . When placentation (ie, placental location) does not allow percutaneous entry to the uterine cavity and covers the anterior part of the uterus completely (ie, complete anterior placenta), surgeons can use a laparoscopic‐assisted approach to access the uterus from the posterior side of the patient’s flank 4,5 .…”

“…In many cases, the surgeons can complete the procedure through a small incision in the abdomen and use 10‐ or 12‐Fr cannulas as laparoscopic ports to provide percutaneous access to the uterine cavity 4 . When placentation (ie, placental location) does not allow percutaneous entry to the uterine cavity and covers the anterior part of the uterus completely (ie, complete anterior placenta), surgeons can use a laparoscopic‐assisted approach to access the uterus from the posterior side of the patient’s flank 4,5 . The laparoscopic‐assisted approach improves the surgeon’s visualization of the posterior uterine wall and allows the surgical team to identify and ablate vascular connections.…”