Direct visual control on cord coagulation using a fetoscopy-guided bipolar forceps. Description of a new technique
Masami Yamamoto1, Gerard Barki, Yves Ville
1Department of Obstetrics and Gynecology, Groupe Hospitalier, Necker-Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, Paris, France.
Objective:
We describe a new technique to achieve permanent umbilical cord occlusion.
Methods:
A 3 mm in diameter bipolar diathermy forceps was built to house a 1.2 mm fetoscope, emerging between the blades of the forceps. The device can be inserted percutaneously through a 10 Fr Trocar into the amniotic cavity under local analgesia and ultrasound guidance. A monochorionic (MC) twin pregnancy with a twin reversed arterial perfusion sequence at 18 weeks of gestation underwent cord occlusion of the acardiac twin using this new device in 2004.
Results:
The instrument allowed cord coagulation under direct visual control. The pregnancy continued until 33 weeks of gestation when a male infant of 1980 g was delivered by cesarean section following preterm labor.
Conclusion:
This new instrument might allow easier access to the cord and reduce operation time by direct visualization of the target and, therefore, improve the outcome after the procedure.
