title: Novel Application of Laparoscopic Ultrasound for Fetoscopic Laser Ablation in Twin-Twin Transfusion Syndrome with Complete Anterior Placenta.
abstract: Fetoscopic laser coagulation of the placental communicating vessels has become the standard treatment for monochorionic/diamniotic twin pregnancies complicated by severe twin-twin transfusion syndrome. Fetoscopic trocar placement can be performed with transabdominal ultrasound guidance with a posterior placenta and most anterior placentas that have a safe avascular window for entry. However, trocar insertion is challenging in cases of a complete anterior placenta without an avascular window. Current techniques to deal with this situation include mini-laparotomy with exteriorization to allow for dorsal entry, percutaneous lateral entry under transabdominal ultrasound/Doppler guidance, and laparoscopic assisted access with direct visualization of trocar entry. We describe a modified technique of laparoscopic assisted fetoscopic trocar placement using a laparoscopic ultrasound probe, which allows for precise, real-time guidance of trocar placement.
authors.affiliation: Pediatric Surgery Section, Department of Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, Fetal Diagnosis and Treatment Center, University of Michigan, Ann Arbor, Mich., USA.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Jarboe
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Berman
authors.forename: Tiffany
authors.initials: T
authors.lastname: Wright
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Treadwell
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D000328:Adult; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017075:Laser Coagulation / Q000379:methods; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000295:instrumentation / Q000379:methods*