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.
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.


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).


CONCLUSIONS
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.
Quintero
Ruben A
RA
Department of Obstetrics and Gynecology, University of Miami, Miami 33101, Florida, USA. rquintero@med.miami.edu
Chmait
Ramen H
RH
Bornick
Patricia Wiseman
PW
Kontopoulos
Eftichia V
EV
D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017075:Laser Coagulation / Q000295:instrumentation / Q000379:methods*; D010920:Placenta / Q000098:blood supply / Q000473:pathology; D011247:Pregnancy; D013525:Surgical Instruments; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal