The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation

Fetoscopic laser surgery for severe Twin-Twin Transfusion Syndrome (TTTS) has been conducted since early 1990s in United States and Europe. After the conclusion of Eurofetus in the randomized clinical trial [1], fetoscopic laser surgery has become the standard and optimal treatment for the TTTS condition. Recently, the techniques have been implemented throughout the globe; many institutions have instituted the performance of fetoscopic laser surgery. As with many new procedures, fetoscopic laser surgery has a steep learning curve for a variety of reasons, i.e., challenging placental location, complex and unexpected communicating anastomoses, dividing membrane lifting, residual anastomoses after surgery, or discolored amniotic fluid. The laser surgery has been performed in Japan since 2002, and five laser centers employ the same protocols. More than 700 TTTS cases, 180 cases were treated by laser surgery to date in our institution. The new technical tips to improve the achievement of successful outcome will be introduced and reviewed for laser surgery and our data of perinatal outcome and complication of fetoscopic laser surgery for severe TTTS will be indicated in this article.