Novel Application of Laparoscopic Ultrasound for Fetoscopic Laser Ablation in Twin-Twin Transfusion Syndrome with Complete Anterior Placenta

作者：Jarboe Marcus D^*; Berman Deborah R; Wright Tiffany; Treadwell Marjorie C; Mychaliska George B

来源：Fetal Diagnosis and Therapy, 2017, 41(1): 71-75.

DOI：10.1159/000439526

• Laser coagulation
• Anterior placenta
• Twin-twin transfusion syndrome
• Fetal therapy
• Laser therapy
• Laparoscopic ultrasound

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 ultra sound 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 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.

• 出版日期2017