title: A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation.
abstract: OBJECTIVE
  The aim of this study is to clarify the feasibility and efficacy of fetoscopic laser photocoagulation of placental vascular communicating vessels (FLP) on twin-twin transfusion syndrome (TTTS) after 26 weeks of gestation.
  
  
  METHODS
  This is a prospective pilot study investigating all cases of TTTS between 26 weeks and 27 weeks during 2012 and 2013 in Japan. The primary endpoints in this study were the feasibility of FLP and rate of harmful complications for the mother's health. Also, perinatal prognosis was investigated.
  
  
  RESULTS
  Six cases were enrolled and underwent FLP. Two of the six cases were classified preoperatively as Quintero Stage II and four cases were Stage III. FLP was completely achieved in all six cases. No severe maternal complications were noted during and immediately after the surgery. All but one case continued the pregnancies > 14 days after FLP. The median gestational age at delivery was 33.4 weeks (28.0-36.6 weeks). All 12 fetuses survived at the 28(th) day in the neonatal period. No case was diagnosed with cerebral lesion at the neonatal period.
  
  
  CONCLUSIONS
  This prospective pilot study shows that FLP could be a therapeutic option for TTTS between 26 weeks and 27 weeks of gestation.
authors: Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan; Perinatal Care Center, Tokuyama Central Hospital, Shunan, Japan. Electronic address: masahiko.nakata@med.toho-u.ac.jp.
authors: Masahiko
authors: M
authors: Nakata
authors: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors: Keisuke
authors: K
authors: Ishii
authors: Fetal Medicine, National Center of Child Health and Development, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Sumie
authors: Perinatal Care Center, Tokuyama Central Hospital, Shunan, Japan.
authors: Mayumi
authors: M
authors: Takano
authors: Perinatal Care Center, Tokuyama Central Hospital, Shunan, Japan.
authors: Hiroko
authors: H
authors: Hirata
authors: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
authors: Susumu
authors: S
authors: Murata
authors: Nagara Medical Center, Gifu, Japan.
authors: Yuichiro
authors: Y
authors: Takahashi
authors: Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors: Takeshi
authors: T
authors: Murakoshi
authors: Fetal Medicine, National Center of Child Health and Development, Tokyo, Japan.
authors: Haruhiko
authors: H
authors: Sago
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000196:embryology / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D017075:Laser Coagulation / Q000379:methods*; D050498:Live Birth; D010865:Pilot Projects; D010920:Placenta / Q000098:blood supply / Q000601:surgery; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D016896:Treatment Outcome; D014430:Twins, Monozygotic
keywords: fetal therapy; fetoscopic surgery; laser surgery; monochorionic pregnancies; twin-to-twin transfusion syndrome