title: A worldwide survey of laser surgery for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  To evaluate differences between international fetal centers in their treatment of twin-twin transfusion syndrome (TTTS) by fetoscopic placental laser coagulation.
  
  
  METHODS
  Fetal therapy centers worldwide were sent a web-based questionnaire. Participants were identified through networks and through scientific presentations and papers. Questions included physician and center demographics, treatment criteria, operative technique and instrumentation. Laser treatment was compared between low-volume (< 20 procedures/year) and high-volume (≥ 20 procedures/year) centers. Data were analyzed using descriptive statistics.
  
  
  RESULTS
  Of 106 fetal therapy specialists approached, 76 (72%) from 64 centers in 25 countries responded. Of these, 48% (31/64) of centers and 63% (48/76) of operators performed fewer than 20 laser procedures annually. Comparison of low- and high-volume centers showed differences in technique, gestational age limits for treatment and geography. High-volume centers more often used the Solomon technique and applied wider gestational age limits for treatment. Europe and Asia had more high-volume centers, whereas South America, the Middle East and Australia had mainly low-volume centers.
  
  
  CONCLUSIONS
  This survey revealed significant differences between fetal centers in several aspects of fetoscopic placental laser therapy for TTTS. Increasing awareness of TTTS, and of laser coagulation as its preferred treatment, will lead to an increase in centers offering this modality, especially in Asia, Africa, South America and the Middle East. Considering the rarity of TTTS and the relative complexity of the procedure, developing international guidelines for techniques, instrumentation and suggested minimum volumes per center may aid in optimizing perinatal outcome.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Akkermans
authors.forename: S H P
authors.initials: SH
authors.lastname: Peeters
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
authors.forename: G
authors.initials: G
authors.lastname: Ryan
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000328:Adult; D005260:Female; D046128:Fetal Therapies / Q000706:statistics & numerical data*; D005330:Fetofetal Transfusion / Q000601:surgery*; D014943:Global Health; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014427:Twins
keywords: TTTS; laser therapy; management; monochorionic twin; survey