Laser for twin-to-twin transfusion syndrome: a guide for endoscopic surgeons

Area of Science:

• Maternal-Fetal Medicine
• Fetal Surgery
• Neonatal Neurology

Background:

• Twin-to-twin-transfusion syndrome (TTTS) is a major cause of mortality and morbidity in monochorionic twin pregnancies.
• The condition arises from placental vascular anastomoses, causing unequal blood flow and fluid distribution between fetuses.
• Untreated TTTS leads to severe complications, including cardiac dysfunction and high fetal mortality.

Purpose of the Study:

• To review the efficacy and safety of fetoscopic laser treatment for TTTS.
• To describe the technique and instrumentation used in fetoscopic laser coagulation.
• To highlight the benefits of laser therapy in improving fetal survival and reducing neurological complications.

Main Methods:

• Fetoscopic laser coagulation targets and seals abnormal vascular connections (anastomoses) between the two fetal circulations on the shared placenta.
• The procedure aims to functionally separate the placental circulations, thereby arresting the inter-twin transfusion.
• Redundant amniotic fluid is also managed during the procedure.

Main Results:

• Fetoscopic laser therapy is recognized as the optimal first-line treatment for TTTS, supported by Level I evidence.
• The procedure has demonstrated increased fetal survival rates.
• A significant decrease in neonatal and pediatric neurological morbidity has been observed post-treatment.

Conclusions:

• Fetoscopic laser coagulation of placental anastomoses is a safe and effective causative therapy for TTTS.
• This minimally invasive procedure offers improved outcomes for monochorionic twins affected by TTTS.
• The technique is standardized and highly effective when performed by experienced specialists.