Sequential laser surgery for twin-twin transfusion syndrome
Ramen H Chmait1, Eftichia V Kontopoulos2, Rubén A Quintero2
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
American Journal of Perinatology
|June 18, 2014
Summary
Sequential selective laser photocoagulation (SQLPCV) offers improved outcomes for twin-twin transfusion syndrome (TTTS) by targeting vascular communications in a specific order, potentially stabilizing hemodynamics in donor twins.
Area of Science:
- Fetal Medicine
- Maternal-Fetal Medicine
- Surgical Innovation
Background:
- Twin-twin transfusion syndrome (TTTS) is a serious complication of monochorionic pregnancies.
- Standard selective laser photocoagulation (SLPCV) aims to occlude placental vascular communications.
- The hemodynamic impact of vessel occlusion order in TTTS is not fully understood.
Purpose of the Study:
- To describe the pathophysiological rationale for the sequential selective laser photocoagulation of communicating vessels (SQLPCV) technique.
- To delineate the surgical technique of SQLPCV for TTTS.
- To review existing literature and identify future research questions regarding SQLPCV.
Main Methods:
- The SQLPCV technique involves sequential laser occlusion of arteriovenous communications.
- Donor-to-recipient communications are lasered first, followed by recipient-to-donor communications.
- This approach aims to induce transient net transfusion to the donor twin.
Main Results:
- The SQLPCV technique may facilitate intraoperative hemodynamic equilibrium, particularly in volume-depleted donor twins.
- Preliminary evidence suggests improved perinatal outcomes compared to standard SLPCV.
- The specific occlusion order may mitigate adverse hemodynamic shifts.
Conclusions:
- The SQLPCV technique presents a potentially improved surgical strategy for TTTS.
- Further research is needed to fully elucidate the benefits and optimal application of SQLPCV.
- Understanding the pathophysiological basis supports the rationale for this sequential approach.
