Computer‐assisted fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: Recent trends and prospects

Schot, Anouk M van der; Sikkel, Esther; Spaanderman, M.E.A.; Vandenbussche, Frank P H A

doi:10.1002/pd.6225

Cited by 5 publications

(2 citation statements)

References 53 publications

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“…On the other hand, smaller cannula diameter decreases the field of view and increases the risk of incomplete surgery, which also negatively affects pregnancy outcome 24 . To overcome both considerations, attempts have been made to artificially expand the field of view during fetoscopy using computer‐assisted interventions 30 . In addition, several studies have identified possible factors in surgical techniques to improve PPROM rates after fetal laser surgery, like using the Seldinger technique during fetoscopic port insertion, a chorioamnion plug, or sealing the membranes 28 …”

Section: Discussionmentioning

confidence: 99%

Impact of cannula diameter on pregnancy outcomes after minimally invasive fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: A systematic review and meta‐analysis

van der Schot,

van Steenis,

Sikkel

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionPreterm prelabor rupture of membranes (PPROM) remains a major complication of fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome (TTTS). The aim of the study was to determine the impact of cannula size on pregnancy outcomes, with a particular focus on PPROM.Material and methodsThe protocol was developed and registered in the PROSPERO database under registration number CRD42022333630. The PubMed, Web of Science, and EMBASE databases were searched electronically on May 18, 2022, and updated on March 2, 2023, utilizing a combination of the relevant MeSH terms, keywords, and word variants for “TTTS” and “laser”. Randomized controlled trials, prospective and retrospective cohorts, case–control studies, and case reports/series with more than five participants were considered eligible for inclusion. Studies reporting the cannula diameter and PPROM rate after laser surgery in the treatment of monochorionic pregnancies affected by TTTS between 16‐ and 26 weeks' gestation were included. Data was extracted independently, and when appropriate, a random‐effects meta‐analysis was undertaken to calculate pooled estimates and their confidence intervals. Heterogeneity in the effect estimates of the individual studies was calculated using the I2 statistic. The primary outcome was PPROM rate. Secondary outcomes were survival rate, preterm birth, and incomplete surgery. The quality of the included studies was assessed using a modified quality in prognosis study tool.ResultsWe included a total of 22 studies, consisting of 3426 patients. Only one study was scored as low quality, seven as moderate quality, and the remaining 14 as high quality. The mean PPROM rate after laser surgery treating TTTS was 22.9%, ranging from 11.6% for 9 French (Fr) to 54.0% for 12 Fr. Subsequent meta‐regression for the clinically relevant PPROM rate before 34 weeks of gestation, showed increased PPROM rates for increased cannula size (p‐value 0.01).ConclusionsThis systematic review confirmed PPROM as a frequent complication of fetal laser surgery, with a mean PPROM rate of 22.9%. A larger cannula diameter relates to a significant higher PPROM risk for PPROM before 34 weeks gestation. Hence, the ideal balance between optimal visualization requiring larger port diameters and shorter operation time and more complete procedures that benefit from larger diameters is crucial to reduce iatrogenic PPROM rates.

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Section: Discussionmentioning

confidence: 99%

Impact of cannula diameter on pregnancy outcomes after minimally invasive fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: A systematic review and meta‐analysis

van der Schot,

van Steenis,

Sikkel

et al. 2024

Acta Obstet Gynecol Scand

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“…The fetoscopic laser procedure is challenging, mainly due to the fetoscope's limited field of view, leading to increased procedural time and incomplete ablation of anastomoses. Computer-assisted technologies, like placental vessel segmentation and fetoscopic image stitching algorithms for the fetal environment, have been developed to overcome the limited field of view challenges by supporting the identification of the placental vessels and anastomoses [2].…”

Section: Introductionmentioning

confidence: 99%

Placental Vessel Segmentation Using Pix2pix Compared to U-Net

van der Schot,

Sikkel,

Niekolaas

et al. 2023

J. Imaging

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Computer-assisted technologies have made significant progress in fetoscopic laser surgery, including placental vessel segmentation. However, the intra- and inter-procedure variabilities in the state-of-the-art segmentation methods remain a significant hurdle. To address this, we investigated the use of conditional generative adversarial networks (cGANs) for fetoscopic image segmentation and compared their performance with the benchmark U-Net technique for placental vessel segmentation. Two deep-learning models, U-Net and pix2pix (a popular cGAN model), were trained and evaluated using a publicly available dataset and an internal validation set. The overall results showed that the pix2pix model outperformed the U-Net model, with a Dice score of 0.80 [0.70; 0.86] versus 0.75 [0.0.60; 0.84] (p-value < 0.01) and an Intersection over Union (IoU) score of 0.70 [0.61; 0.77] compared to 0.66 [0.53; 0.75] (p-value < 0.01), respectively. The internal validation dataset further validated the superiority of the pix2pix model, achieving Dice and IoU scores of 0.68 [0.53; 0.79] and 0.59 [0.49; 0.69] (p-value < 0.01), respectively, while the U-Net model obtained scores of 0.53 [0.49; 0.64] and 0.49 [0.17; 0.56], respectively. This study successfully compared U-Net and pix2pix models for placental vessel segmentation in fetoscopic images, demonstrating improved results with the cGAN-based approach. However, the challenge of achieving generalizability still needs to be addressed.

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Computer‐assisted fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: Recent trends and prospects

et al. 2022

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Fetal laser surgery has emerged as the preferred treatment of twin-to-twin transfusion syndrome (TTTS). However, the limited field of view of the fetoscope and the complexity of the procedure make the treatment challenging. Therefore, preoperative planning and intraoperative guidance solutions have been proposed to cope with these challenges. This review uncovers the literature on computerassisted software solutions focused on TTTS. These solutions are classified by the pre-or intraoperative phase of the procedure and further categorized by discussed hardware and software approaches. In addition, it evaluates the current maturity of technologies by the technology readiness level and enumerates the necessary aspects to bring these new technologies to clinical practice. Key points What's already known about this topic?This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Computer‐assisted fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: Recent trends and prospects

Cited by 5 publications

References 53 publications

Impact of cannula diameter on pregnancy outcomes after minimally invasive fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: A systematic review and meta‐analysis

Impact of cannula diameter on pregnancy outcomes after minimally invasive fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: A systematic review and meta‐analysis

Placental Vessel Segmentation Using Pix2pix Compared to U-Net

Computer‐assisted fetal laser surgery in the treatment of twin‐to‐twin transfusion syndrome: Recent trends and prospects

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