Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

Abstract

We evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. The incidence rates of recurrent TTTS (Solomon vs. selective: 0% vs. .9%, p = .510) and twin anemia–polycythemia sequence (.6% vs. .4%, p = .670) were very low in both groups. The incidence rates of placental abruption (Solomon vs. selective: 10.7% vs. 3.5%, p = .007) and preterm premature rupture of the membranes (pPROM) with subsequent delivery before 32 weeks (20.2% vs. 7.1%, p < .001) were higher in the Solomon group. The median birth recipient weight was significantly smaller in the Solomon group (1790 g vs. 1933 g, p = .049). The rate of survival of at least one twin was significantly higher in the Solomon group (98.2% vs. 93.8%, p = .046). The Solomon technique and total laser energy were significant risk factors for pPROM (odds ratio: 2.64, 1.07, 95% CI [1.32, 5.28], [1.01, 1.13], p = .006, p = .014, respectively). These findings suggest that the Solomon technique led to superior survival outcomes but increased risks of placental abruption, pPROM and fetal growth impairment. Total laser energy was associated with the occurrence of pPROM. Close attention to adverse events is required for perinatal management after FLS to treat TTTS using the Solomon technique.

Anesthesia for fetal operative procedures: A systematic review

“…Ninety-seven studies, accounting for 4,070 pregnancies, were included in the baseline characteristics and outcome analysis for MA ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 117 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 , 178 ). The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , …”

“…The mean LOH resulted to be 4.98 days, based on 24 studies involving 903 women ( 21 , 24 , 28 , 29 , 40 , 46 , 52 , 64 , 73 , 77 , 84 , 90 , 91 , 93 , 99 , 105 , 114 , 115 , 120 , 134 , 137 , 149 , 155 , 173 ). Sixty-four studies, with 3,032 pregnancies, resulted in an aggregated mean GA at delivery of 33.39 weeks ( 11 , 22 , 27 – 29 , 33 , 39 , 40 , 46 , 50 , 51 , 58 , 61 , 64 , 65 , 69 , 73 – 78 , 80 , 81 , 87 , 90 – 93 , 94 , 96 , 99 , 101 , 102 , 105 , 107 , 113 – 117 , 120 , 122 , 130 – 134 , 137 – 139 , 152 , 154 – 157 , 159 , 160 , 164 , …”

“…Ninety-five studies (3,905 pregnancies) were included for the comparative analysis of the anesthesia administration's routes ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 116 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 ). No statistically significant differences were found in the baseline characteristics and outcomes between patients receiving loco-regional and general anesthesia ( Table 1 ).…”

Predictive values of first trimester ultrasound screening for twin-to-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic twin pregnancies

“…The best treatment for twin-twin transfusion syndrome (TTTS) is fetoscopic laser coagulation of the vascular anastomoses, preferably using the Solomon laser technique (Kanazawa et al, 2021). Greimel et al show that this surgical intervention is safe and rarely associated with maternal procedure-related complications (Greimel et al, 2019).…”

New challenges of fetal therapy in Japan

“…23 With our favorable findings, FLS has also been applied for triplets, 24 TTTS at 26-27 weeks 25,26 and selective intrauterine growth restriction with oligohydramnios. 27,28 With the introduction of the Solomon technique and the accumulation of experience, we have achieved a very high survival rate (the at least one survival rate was >98%) 29 with favorable long-term neurodevelopmental outcomes for TTTS treated by FLS. 30 TAS was the second fetal therapy to be compensated by Japan National Health Insurance, with the favorable results of our prospective one-arm trial using a "double-basket catheter" (Hakko Co., Nagano, Japan).…”