title: 'A problem shared is a problem halved': success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin-twin transfusion syndrome in Victoria.
abstract: OBJECTIVE
  To evaluate the performance of a collaborative fetal therapy service for treatment for twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is a state-based three-centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in Victoria. This is a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation (FLP) for TTTS since 2006.
  
  
  RESULTS
  Forty-nine consecutive women with advanced (stage 2-4) TTTS between 2006 and 2011 were included in this study. Overall survival was 67 of 98 (68%), and survival of ≥1 twin was seen in 42 of 49 pregnancies (86%). There was no difference in survival by disease stage at diagnosis (≥1 survivor: 66% (stage 2 or 3 TTTS) vs 77% (stage 4 TTTS), P = 0.44), nor by surgical era (≥1 survivor: 60% (2006-2008) vs 74% of cases (2009-2011), P = 0.21). The median gestation gained post-FLP was 10.5 weeks.
  
  
  CONCLUSIONS
  These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in Victoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow-up of patients and to optimise training and research opportunities.
authors.affiliation: Fetal Diagnostic Unit, Monash Medical Centre, Clayton, Victoria, Australia. markteoh@bigpond.net.au
authors.forename: Mark
authors.initials: M
authors.lastname: Teoh
authors.forename: Sue
authors.initials: S
authors.lastname: Walker
authors.forename: Stephen
authors.initials: S
authors.lastname: Cole
authors.forename: Andrew
authors.initials: A
authors.lastname: Edwards
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005865:Gestational Age; D006078:Government Programs / Q000458:organization & administration*; D006801:Humans; D017075:Laser Coagulation; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014739:Victoria