title: Laparoscopy-assisted fetoscopy for laser surgery in twin-twin transfusion syndrome with anterior placentation.
abstract: OBJECTIVE
  To compare a laparoscopy-assisted fetoscopic approach with an ultrasound-directed percutaneous approach for laser photocoagulation of placental anastomoses in cases of twin-twin transfusion syndrome (TTTS) with anterior placentation.
  
  
  METHODS
  We performed a retrospective review of all cases that underwent laser ablation of placental anastomoses for TTTS with an anterior placenta at Texas Children's Fetal Center from November 2006 to November 2008. The two cohorts were identified by chart review based on the type of approach: laparoscopy-assisted vs. ultrasound-guided percutaneous uterine entry for fetoscopy. Operative and outcome data were extracted and the groups were compared using statistical methods, taking P < 0.05 as statistically significant.
  
  
  RESULTS
  In the 100 cases of TTTS studied, 48 had an anterior placenta. Fifteen (31%) of these underwent laparoscopy-assisted fetoscopy (LAF) while a percutaneous approach was used in the remaining 33 (69%) cases. The total procedure time was longer in the LAF group than in the percutaneous group (96.1 +/- 25 vs. 67.9 +/- 28 min; P < 0.01). There was no difference in the rate of preterm premature rupture of membranes up to 2 weeks and 4 weeks after surgery (7 vs. 15% and 13 vs. 21%, for the LAF group vs. the percutaneous group, respectively; P = 0.7). The gestational ages at delivery were similar: 30.3 +/- 4.5 weeks in the LAF group and 29.2 +/- 4.6 weeks in the percutaneous group (P = 0.32). The overall survival rate at birth was tending towards better survival in the laparoscopic group than in the percutaneous group (80 vs. 61%, respectively; P = 0.06). The neonatal survival rate was better with the LAF approach than with the percutaneous approach (80 vs. 59%, respectively; P = 0.045).
  
  
  CONCLUSIONS
  Laparoscopy-assisted entry of the uterus is associated with improved neonatal survival for laser photocoagulation in cases of TTTS with a complete anterior placentation.
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX 77030, USA. papanna@bcm.edu
authors.forename: R
authors.initials: R
authors.lastname: Papanna
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.forename: R T
authors.initials: RT
authors.lastname: Ivey
authors.forename: O O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: D
authors.initials: D
authors.lastname: Cass
authors.forename: K J
authors.initials: KJ
authors.lastname: Moise
mesh_terms: D000328:Adult; D004200:Diseases in Twins / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D010920:Placenta / Q000000981:diagnostic imaging / Q000601:surgery; D010929:Placentation; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery