title: Comparison of Solomon technique with selective laser ablation for twin-twin transfusion syndrome: a systematic review.
abstract: OBJECTIVE
  To compare the Solomon and selective techniques for fetoscopic laser ablation (FLA) for the treatment of twin-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies.
  
  
  METHODS
  This was a systematic review conducted in accordance with the PRISMA statement. Electronic searches were performed for relevant citations published from inception to September 2014. Selected studies included pregnancies undergoing FLA for TTTS that reported on recurrence of TTTS, occurrence of twin anemia-polycythemia sequence (TAPS) or survival.
  
  
  RESULTS
  From 270 possible citations, three studies were included, two cohort studies and one randomized controlled trial (RCT), which directly compared the Solomon and selective techniques for FLA. The odds ratios (OR) of recurrent TTTS when using the Solomon vs the selective technique in the two cohort studies (n = 249) were 0.30 (95% CI, 0.00-4.46) and 0.45 (95% CI, 0.07-2.20). The RCT (n = 274) demonstrated a statistically significant reduction in risk of recurrent TTTS with the Solomon technique (OR, 0.21 (95% CI, 0.04-0.98); P = 0.03). The ORs for the development of TAPS following the Solomon and the selective techniques were 0.20 (95% CI, 0.00-2.46) and 0.61 (95% CI, 0.05-5.53) in the cohort studies and 0.16 (95% CI, 0.05-0.49) in the RCT, with statistically significant differences for the RCT only (P < 0.001). Observational evidence suggested overall better survival with the Solomon technique, which was statistically significant for survival of at least one twin. The RCT did not demonstrate a significant difference in survival between the two techniques, most probably owing to the small sample size and lack of power.
  
  
  CONCLUSIONS
  This systematic review of observational, comparative cohort and RCT data suggests a trend towards a reduction in TAPS and recurrent TTTS and an increase in twin survival, with no increase in the occurrence of complications or adverse events, when using the Solomon compared to the selective technique for the treatment of TTTS. These findings need to be confirmed by an appropriately-powered RCT with long-term neurological follow-up.
authors: Centre for Women's & Children's Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors: R K
authors: RK
authors: Dhillon
authors: Centre for Women's & Children's Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors: S C
authors: SC
authors: Hillman
authors: Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK.
authors: R
authors: R
authors: Pounds
authors: Centre for Women's & Children's Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.|Fetal Medicine Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors: R K
authors: RK
authors: Morris
authors: Centre for Women's & Children's Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.|Fetal Medicine Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors: M D
authors: MD
authors: Kilby
mesh_terms: D001163:Arteriovenous Anastomosis / Q000196:embryology / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D017075:Laser Coagulation / Q000295:instrumentation / Q000379:methods*; D064887:Observational Studies as Topic; D010920:Placenta / Q000098:blood supply / Q000601:surgery*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014427:Twins
keywords: Solomon; equatorial dichorionization; laser; selective; twin-twin transfusion syndrome