title: Short-term outcomes of fetoscopic laser surgery for severe twin-twin transfusion syndrome from Taiwan single center experience: demonstration of learning curve effect on the fetal outcomes.
abstract: OBJECTIVE
  To evaluate the learning curve effect on fetal outcomes while using fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) as managed by a newly established single center in Taiwan.
  
  
  METHODS
  Between October 2005 and October 2010, women diagnosed to have TTTS before 26 weeks of gestation were offered FLP surgery. Cases were divided into first-half and second-half groups to evaluate the learning effect on fetal outcomes including at least one survival rate, two survival rate, and gestational age of delivery.
  
  
  RESULTS
  A total of 44 cases with a median gestational age of 20.1 weeks (range 16-25) at operation were included in the study. Overall, both twins survived in 22 (50.0%) cases, whereas only one twin was born alive in 13 (29.5%), and neither was born alive in the remaining nine cases (20.5%). The total survival rate was 64.8%. When comparing the first-half 22 cases and the second-half 22 cases, there were significant improvements in total survival rate (54.7% vs. 75.0%, p = 0.045), a prolonged interval between operation and delivery (62.1 vs. 89.1 days, p = 0.042), and more advanced gestational age of delivery (28.3 vs. 33.0 weeks, p = 0.008) in the second-half 22 cases.
  
  
  CONCLUSIONS
  With increasing experience in using fetoscopic guide laser therapy for TTTS, the fetal survival rate could be improved with advanced gestational age at delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. j12054@cgmh.org.tw
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.forename: An-Shine
authors.initials: AS
authors.lastname: Chao
authors.forename: Shuenn-Dyh
authors.initials: SD
authors.lastname: Chang
authors.forename: Peter C C
authors.initials: PC
authors.lastname: Hsieh
authors.forename: Chao-Nin
authors.initials: CN
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods / Q000523:psychology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods / Q000523:psychology*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059032:Learning Curve; D011247:Pregnancy; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult