Fetoscopic Laser Surgery: Procedure, Benefits and Success Rates

What is Fetoscopic Laser Surgery?

Fetoscopic laser surgery is a minimally invasive procedure used to treat certain conditions in unborn babies, typically when there are problems with the placenta. It involves using a special laser through a small camera (fetoscope) inserted into the womb to treat issues like twin-to-twin transfusion syndrome (TTTS), where twins share blood vessels in the placenta unevenly.

Efficacy Of Fetoscopic Laser Surgery

Survival Rates:

• A study involving 181 cases found that at 28 days and 6 months after surgery, at least one twin survived in 91.2% and 90.1% of cases, respectively.
• Another study with 57 cases reported an immediate fetal survival rate of 67.4%, with at least one twin surviving in 87.0% of pregnancies.
• A large study of 1,020 cases observed an increase in double-twin survival rates from 50% to 70% over time, reflecting improvements in technique and experience.

Neonatal Outcomes:

• The same study of 181 cases reported a major neurological complication rate of 4.7% among survivors at 6 months. ​

How is Fetoscopic Laser Surgery Performed?

1. Preparation:
   • The procedure is usually done under general anesthesia or regional anesthesia to ensure the mother is comfortable and the baby is not stressed.
   • The mother’s abdomen is cleaned and sterilized and a catheter is inserted to monitor the baby’s heart rate.
2. Insertion of the Fetoscope:
   • A small incision is made in the mother’s abdomen and a long, thin tube called a fetoscope (a specialized type of endoscope) is carefully inserted into the uterus through the incision.
   • The fetoscope has a tiny camera on the end, which allows the surgeon to see the inside of the uterus and the position of the babies.
3. Laser Treatment:
   • Using the fetoscope, the surgeon can see the abnormal blood vessels between the twins (often seen in conditions like twin-to-twin transfusion syndrome).
   • A laser is passed through the fetoscope to target and seal off the abnormal blood vessels, effectively stopping the uneven blood flow between the twins.
4. Completion:
   • The surgeon checks to ensure that the laser has effectively sealed the blood vessels and that both babies are stable.
   • Once the procedure is complete, the fetoscope is removed and the incision is closed.
5. Post-Procedure Monitoring:
   • The mother and babies are closely monitored after the surgery, often with ultrasounds and fetal heart rate monitoring, to ensure there are no complications and that the babies are progressing well.

The procedure usually takes about 30 to 60 minutes and the risks are relatively low but it requires careful expertise due to the delicate nature of the surgery.

What is The Success Rate Of Laser Fetoscopy?

Survival Rate:

• At least one twin survives in about 80-90% of cases.
• Both twins surviving occurs in around 50-70% of cases, with some studies reporting improvements in these numbers over time due to advances in surgical technique and prenatal care.

Neonatal Outcomes:

• A study of 181 cases reported a neonatal survival rate of approximately 80-85% for at least one twin.
• Major neurological complications in surviving babies occur in about 5-10% of cases, although this rate can vary.

Long-Term Outcomes:

• Survival rates are high in the early months after surgery but long-term follow-up shows that about 90% of babies who survive the procedure do well without major health issues.

What Are The Complications of Fetoscopic Laser Surgery?

1. Premature Labor

• Fetoscopic laser surgery may trigger premature labor, especially if the procedure is performed earlier than recommended (before 16 weeks of gestation).
• The risk of premature birth increases if there are additional complications or if the uterus is irritated during the surgery.

2. Infection

• Any surgical procedure carries the risk of infection. Although the surgical site is sterilized, there is still a chance that the uterus or amniotic sac could become infected.

3. Fetal Injury

• There’s a risk of unintentional injury to the fetuses during the procedure, such as puncturing the placenta or amniotic sac or damaging the fetus while inserting the fetoscope or laser.
• In rare cases, the laser can cause accidental damage to surrounding tissues.

4. Blood Vessel Rupture

• Laser surgery targets abnormal blood vessels but there’s a small risk that healthy blood vessels could be damaged, leading to hemorrhaging or other vascular issues in the uterus.

5. Amniotic Fluid Leakage

• The procedure can lead to leakage of amniotic fluid from the uterus, which could affect the pregnancy and increase the risk of infection or preterm labor.

6. Multiple Pregnancy Complications

• If the pregnancy involves more than two fetuses or if there are additional complications (e.g., other placenta-related issues), the procedure may not have as positive an outcome and the risk of complications increases.

7. Neurological Issues in Babies

• Although rare, some babies may develop neurological problems as a result of the surgery, particularly if there were complications during the procedure that affected their development.

8. Miscarriage or Stillbirth

• There is a risk, although small, of miscarriage or stillbirth following fetoscopic laser surgery, especially if complications occur during the procedure or if the pregnancy is too premature.

9. Recurrence of TTTS

• In some cases, twin-to-twin transfusion syndrome (TTTS) can recur after laser surgery, requiring additional interventions.

In What Cases is Fetoscopic Laser Surgery Necessary?

1. Twin-to-Twin Transfusion Syndrome (TTTS)

• TTTS occurs in monochorionic (sharing a single placenta) identical twins. In this condition, blood vessels in the placenta connect the twins, leading to an imbalance in blood flow—one twin (the donor) loses blood and becomes anemic, while the other (the recipient) receives too much blood and may develop heart problems.
• Fetoscopic laser surgery is the most common treatment for TTTS. It involves using a laser to seal off the abnormal blood vessels between the twins, which helps to balance their blood circulation and improves the chances of both twins surviving and thriving.

2. Twin Anemia-Polycythemia Sequence (TAPS)

• TAPS is a related condition that can occur in monochorionic twin pregnancies, where one twin develops anemia (too little blood) and the other develops polycythemia (too much blood), caused by an imbalance in placental blood flow.
• Like TTTS, fetoscopic laser surgery may be used to treat TAPS by cutting or sealing the vessels causing the blood flow imbalance, though this condition is less common and may sometimes require a different treatment approach.

3. Selective Intrauterine Growth Restriction (sIUGR)

• In monochorionic twin pregnancies, one twin may be much smaller than the other (growth restriction), which is often caused by abnormal placental blood flow.
• In severe cases, where the growth restriction is linked to placental vascular issues, fetoscopic laser surgery may be used to correct the abnormal blood vessels contributing to the growth restriction.

4. Placental Masses or Abnormalities

• Placental anomalies, such as abnormal blood vessels or masses, can also be treated with fetoscopic laser surgery if they are causing problems for the pregnancy, like abnormal blood flow or hemorrhaging. This is a less common use of the procedure but may be necessary in specific cases.

5. Acardiac Twin Syndrome (Parasitic Twin)

• In rare cases of acardiac twin syndrome, one of the twins is not properly developed (often without a heart), and the other twin pumps blood to the abnormal twin through the shared placenta, leading to life-threatening complications for both babies.
• Fetoscopic laser surgery may be used to cut the blood flow to the acardiac twin to save the healthy twin.

6. Severe Placental Vascular Malformations

• If there are abnormal blood vessels or connections in the placenta that could affect the development of the fetus or put the pregnancy at risk, fetoscopic laser surgery may be performed to treat or correct these malformations, particularly in cases where it poses a direct threat to the fetus’s survival or health.

7. Certain Cases of Monochorionic Monoamniotic Twins

• In very rare cases, when both twins share not only a placenta but also the same amniotic sac (monochorionic monoamniotic), fetoscopic surgery may be used to correct any abnormal vascular connections between the twins or manage complications that arise from this rare condition.

We wish a healthy and heappy life to you. You can find details Twin-to-Twin Transfusion Syndrome (TTTS) in below:

Twin-to-Twin Transfusion Syndrome (TTTS): Causes, Stages and Treatment Options