Trocar-assisted selective laser photocoagulation of communicating vessels: A technique for the laser treatment of patients with twin–twin transfusion syndrome with inaccessible anterior placentas

Abstract

Objective. To describe a new technique, trocar-assisted selective laser photocoagulation of communicating vessels (TA-SLPCV), for patients with twin–twin 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%, p = 0.3), residual patent anastomoses (4.3% vs. 2.7%, p = 0.6), or premature rupture of membranes within 3 weeks of the procedure (7.7% vs. 4%, p = 0.2), was no different relative to placental location (anterior vs. posterior, respectively). Operating time was significantly different between the groups (median 46 min vs. 36 min, 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.

Keywords:

• Laser for anterior placentas
• twins
• twin–twin transfusion syndrome

Acknowledgements

The authors thank Ms. Mary Allen, RN, our Fetal Therapy Coordinator for many years, for her unabated dedication to our patients, our sonographers Karen Pomeroy, Rhonda Mabry, Kerry Dolhancryk, and Mary Toretta for their outstanding ultrasound assessment and intraoperative assistance, Ms. Laura Kersey for the financial assistance to our patients, and our operating room staff for their professional and compassionate care of our patients.