Ultrasound‐guided, intra‐abdominal laser to treat acardiac pregnancies

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

“…In the combined data from previous studies [51,52,53,54,55,56,57,58,59,60] and the current study there were 104 twin pregnancies treated by intrafetal laser. There was no significant association between the gestational age at treatment and survival rate (mean 77.9%, r = 0.066, p = 0.508).…”

“…Early attempts were highly invasive and involved hysterotomy and removal of the acardiac twin [2,3,4]. Subsequently, a series of other less invasive intrauterine interventions aiming to arrest the circulation of the acardiac twin were introduced [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. These included insertion of cord coils, ligation with or without transection of the umbilical cord, endoscopic laser coagulation of placental anastomoses between the pump and acardiac twins, endoscopic laser coagulation and endoscopic or ultrasound-guided monopolar or bipolar diathermy of vessels within the cord supplying the acardiac twin and, more recently, ultrasound-guided ablation of intrafetal vessels by injection of alcohol, monopolar diathermy, laser or radiofrequency.…”

Acardiac acephalus with malformed donor twin

“…The poly-hydraminos which is most commonly seen with this condition can be treated either by medications or by amnioreduction, definitive treatment modalities that cause occlusion of the perfused (acardiac) twin's cord or rudimentary aorta may be achieved by a variety of fetoscopic or ultrasound guided techniques (intrafetal laser ablation, radiofrequency thermal ablation and fetoscopic cord occlu sion with absolute alcohol, platinum coils, thermogenic coils). [9][10][11][12] As described in literature with careful case selection improved outcome for the donor twin may be up to 85%. 13 Most significant complications include cotwin demise or decreased cerebral blood flow and/or preterm ruptured membranes.…”

Instrumental requirements for minimal invasive fetal surgery

“…The overall success rate of cord coagulation is around 80%. 39,40 Intrafetal vessels can be ablated by interstitial laser, 41 monopolar 42 or radiofrequency electrodes 43,44 (e.g. RF 3000 with LeVeen Needle Electrode; Boston Scientific, Natick, MA, USA or Starburst; RITA Medical Systems, Manchester, GA, USA or Cool-tip RF; Valleylab, Tyco Healthcare Group LP, Boulder, CO, USA), with reported survival rates of 76-94% [45][46][47] As this is carried out through needles that are smaller than the above cannulas, it is an attractive alternative particularly early in gestation.…”