Objective.To describe a new technique, trocar-assisted selective laser photocoagulation of communicating vessels (TA-SLPCV), for patients with twintwin transfusion syndrome (TTTS) with inaccessible anterior placentas. Materials and methods.TA-SLPCV was performed through a single port in TTTS patients with an anterior placenta in whom the anastomoses were inaccessible with a standard technique (inaccessible anterior placentas). The anastomoses were first identified using a 25 or 70-degree rigid diagnostic endoscope. The anastomoses were then targeted with a zero-degree operating rigid endoscope by withdrawing it within the sheath a short distance and using the sheath to gently indent the placenta (trocar assistance). The technique was compared with patients with a posterior placenta treated with a standard technique. Surgeries were approved by the Institutional Review Boards and all patients signed informed consent. Results.Of 267 patients who met the criteria for the study, 143 (53.6) had an anterior placenta and 124 (46.4) had a posterior placenta. Perinatal survival (88.1 vs. 91.9, p0.3), residual patent anastomoses (4.3 vs. 2.7, p0.6), or premature rupture of membranes within 3 weeks of the procedure (7.7 vs. 4, p0.2), was no different relative to placental location (anterior vs. posterior, respectively). Operating time was significantly different between the groups (median 46min vs. 36min, p<0.05). Conclusion.Trocar assistance allows treatment of TTTS patients with inaccessible anterior placentas using a single port and a rigid endoscope with similar results as patients with a posterior placenta and a standard technique.
- Laser for anterior placentas
- Twintwin transfusion syndrome
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Obstetrics and Gynecology