title: Residual anastomoses in twin-twin transfusion syndrome after laser: the Solomon randomized trial.
abstract: OBJECTIVE
  Residual anastomoses after fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS) may lead to severe postoperative complications, including recurrent TTTS and twin anemia-polycythemia sequence (TAPS). A novel technique (Solomon technique) using laser coagulation of the entire vascular equator was recently investigated in a randomized controlled trial (Solomon trial) and compared with the Standard selective laser technique. The aim of this secondary analysis was to evaluate the occurrence and characteristics of residual anastomoses in placentas included in the Solomon trial.
  
  
  METHODS
  International multicenter randomized controlled trial in TTTS, randomized 1:1 ratio to either the Solomon laser technique or Standard laser technique. At time of laser, surgeons recorded whether they considered the procedure to be complete. Placental dye injection was performed after birth in the participating centers to evaluate the presence of residual anastomoses.
  
  
  RESULTS
  A total of 151 placentas were included in the study. The percentage of placentas with residual anastomoses in the Solomon group and Standard group was 19% (14/74) and 34% (26/77), respectively (P = .04). The percentage of placentas with residual anastomoses in the subgroup of cases where the procedure was recorded as complete was 8/65 (12%) and 22/69 (32%) in the Solomon group and Standard group, respectively (P < .01).
  
  
  CONCLUSIONS
  The Solomon laser technique reduces the risk of residual anastomoses. However, careful follow-up remains essential also after the Solomon technique, as complete dichorionization is not always achieved.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: f.slaghekke@lumc.nl.
authors.forename: Femke
authors.initials: F
authors.lastname: Slaghekke
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics, CMCO-HUS Strasbourg, Strasbourg, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Weingertner
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Klumper
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Philip
authors.initials: P
authors.lastname: Dekoninck
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.affiliation: Department of Obstetrics, Fetal Therapy Unit, Children's Hospital Vittore Buzzi, Milan, Italy.
authors.forename: Mariano M
authors.initials: MM
authors.lastname: Lanna
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.affiliation: Department of Obstetrics, CMCO-HUS Strasbourg, Strasbourg, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D001163:Arteriovenous Anastomosis / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D053685:Laser Therapy; D011247:Pregnancy
keywords: Solomon; residual anastomoses; twin anemia polycythemia sequence; twin-twin transfusion syndrome