Name of the Procedure:

Fetoscopic Laser Therapy for Treatment of Twin-to-Twin Transfusion Syndrome (S2411)

Summary

Fetoscopic laser therapy is a minimally invasive surgical procedure used to treat twin-to-twin transfusion syndrome (TTTS), a condition affecting identical twins sharing a placenta. This procedure involves using a laser to sever the abnormal blood vessel connections between the twins, which helps to balance blood flow and improve outcomes.

Purpose

Fetoscopic laser therapy addresses twin-to-twin transfusion syndrome (TTTS), a serious condition where one twin (the donor) transfers blood to the other twin (the recipient) through shared placental blood vessels. The primary goal is to stop the unbalanced blood exchange, thus preventing complications such as heart failure, growth restrictions, and neurological damage in the twins.

Indications

• Diagnosis of TTTS via ultrasound.
• Significant disparity in amniotic fluid levels between the twins.
• Cardiovascular compromise in either twin due to TTTS.
• Progressive worsening of the condition despite conservative management.

Preparation

• Fasting for a certain period before the procedure (typically about 8 hours).
• Adjustment or discontinuation of certain medications as advised by the healthcare provider.
• Pre-procedure ultrasound to map the placental vessels and confirm the diagnosis.

• Comprehensive maternal assessment and fetal well-being checks.

  Procedure Description

  1. Anesthesia: Regional (epidural or spinal) or general anesthesia is administered to ensure the mother's comfort.
  2. Insertion: A small incision is made in the mother's abdomen, and a fetoscope (a tiny tube with a camera) is inserted into the amniotic cavity.
  3. Mapping: The surgeon uses the fetoscope to visualize and map the placental blood vessels shared by the twins.
  4. Laser Treatment: A laser fiber is inserted through the fetoscope to coagulate and close the abnormal blood vessels.
  5. Exit: The fetoscope and laser are removed, and the incision is closed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Fetoscopic laser therapy is usually performed in a hospital setting, within a specialized operating room equipped for fetal surgery.

Personnel

• Maternal-fetal medicine specialist or fetal surgeon.
• Anesthesiologist.
• Nurses specifically trained in fetal surgery.
• Ultrasonographer for imaging support.
• Neonatology team for immediate post-operative care if necessary.

Risks and Complications

• Preterm labor or premature rupture of membranes.
• Infection.
• Bleeding.
• Incomplete or unsuccessful closure of blood vessels, potentially requiring additional procedures.
• Loss of one or both twins, depending on severity and timing.

Benefits

• Potential stabilization or improvement in twin health.
• Reduction in complications associated with TTTS, such as heart failure and brain injury.
• Improved survival rates and better long-term outcomes for both twins.

Recovery

• Close monitoring in a hospital for a few days post-procedure.
• Regular follow-up ultrasounds to assess the health and development of both twins.
• Activity restrictions to minimize risks of preterm labor.
• Adherence to prescribed medications to prevent infection or preterm contractions.

Alternatives

• Expectant management with frequent ultrasounds to monitor TTTS progression.
• Amnioreduction: Reducing excess amniotic fluid in the recipient's sac to relieve pressure, though this does not address the underlying cause.
• Selective fetal reduction may be considered in severe cases, though it carries significant ethical and emotional considerations.

Patient Experience

• Patients may feel anxious or uncomfortable due to the surgical setting and anesthesia.
• Mild to moderate pain or cramping at the incision site post-procedure, managed with prescribed pain relief medications.
• Emotional support and counseling may be beneficial due to the high-risk nature of TTTS and the anxiety associated with fetal surgery.