Abstract：
BACKGROUND: Maternal laparotomy-assisted fetoscopic surgery for in-utero myelomeningocele repair has shown that a trans-amniotic membrane suture during fetoscopic port placement can reduce postsurgical complications. Fetoscopic laser photocoagulation (FLP) for complex twins is typically performed percutaneously without a transmembrane stitch. However, in scenarios without a placental-free window, maternal laparotomy may be used for recipient sac access. Here, we present the outcomes of our series of laparotomy-assisted FLP cases, including a trans-amniotic membrane suturing of the fetoscopic port.
METHODS: Retrospective series of twin-twin transfusion syndrome or twin anemia-polycythemia sequence (TAPS) cases treated at 2 fetal centers that underwent maternal laparotomy to FLP from September 2017 to January 2023. We recorded preoperative and operative characteristics, as well as pregnancy and neonatal outcomes.
RESULTS: During the study period, 9 maternal laparotomy to FLP cases were performed. Two were excluded for prior percutaneous FLP in the pregnancy. The remaining seven utilized a maternal laparotomy to trans-amniotic membrane stitch with confirmation of proper suture placement under ultrasound guidance, and all surgeries were performed with a single 10 F Check-Flo® cannula. Mean gestational age (GA) at surgery was 19.1 weeks (range 16 weeks 4 days-23 weeks 3 days), with delivery occurring at a mean GA of 35.0 weeks (range 32 weeks 0 days-37 weeks 1 day), resulting in a mean latency of 15.8 weeks, significantly longer than what is reported in the literature and our own data (mean latency for percutaneous FLP 10.2, 95% CI 9.9-10.5). Furthermore, all cases underwent iatrogenic delivery before labor onset, with the lone delivery prior to 34 weeks due to concern for post-laser TAPS.
CONCLUSIONS: This case series of laparotomy to FLP with trans-amniotic stitch, demonstrated no cases of spontaneous preterm birth and a longer-than-expected latency from surgery to delivery. Larger studies are warranted to investigate this approach.
METHODS: Retrospective series of twin-twin transfusion syndrome or twin anemia-polycythemia sequence (TAPS) cases treated at 2 fetal centers that underwent maternal laparotomy to FLP from September 2017 to January 2023. We recorded preoperative and operative characteristics, as well as pregnancy and neonatal outcomes.
RESULTS: During the study period, 9 maternal laparotomy to FLP cases were performed. Two were excluded for prior percutaneous FLP in the pregnancy. The remaining seven utilized a maternal laparotomy to trans-amniotic membrane stitch with confirmation of proper suture placement under ultrasound guidance, and all surgeries were performed with a single 10 F Check-Flo® cannula. Mean gestational age (GA) at surgery was 19.1 weeks (range 16 weeks 4 days-23 weeks 3 days), with delivery occurring at a mean GA of 35.0 weeks (range 32 weeks 0 days-37 weeks 1 day), resulting in a mean latency of 15.8 weeks, significantly longer than what is reported in the literature and our own data (mean latency for percutaneous FLP 10.2, 95% CI 9.9-10.5). Furthermore, all cases underwent iatrogenic delivery before labor onset, with the lone delivery prior to 34 weeks due to concern for post-laser TAPS.
CONCLUSIONS: This case series of laparotomy to FLP with trans-amniotic stitch, demonstrated no cases of spontaneous preterm birth and a longer-than-expected latency from surgery to delivery. Larger studies are warranted to investigate this approach.
摘要：
背景：产妇剖腹辅助胎儿镜手术治疗宫内脊髓膜膨出修复术表明，在胎儿镜孔放置期间经羊膜缝合可减少术后并发症。复杂双胞胎的胎儿镜激光光凝（FLP）通常是经皮进行的，没有跨膜缝合。然而,在没有胎盘自由窗口的情况下，产妇剖腹手术可用于受体囊通路。这里,我们介绍了一系列剖腹手术辅助FLP病例的结果，包括胎儿镜孔的跨羊膜缝合。
方法：回顾性系列双胎输血综合征（TTTS）或双胎贫血-红细胞增多症（TAPS）病例在2个胎儿中心接受治疗，于2017年9月至2023年1月接受了FLP产妇剖腹手术。我们记录了术前和手术特征，以及妊娠和新生儿结局。
结果：在研究期间，对9例FLP患者进行了剖腹手术。在怀孕期间，有两个被排除在先前的经皮FLP之外。其余7例使用产妇剖腹手术进行羊膜缝合，并在超声引导下确认正确的缝合位置，所有手术均通过锋利的单根10FCheck-Flo®套管进行。手术时的平均胎龄（GA）为19.1周（范围16w4d-23w3d），分娩时平均GA为35.0周（范围32w0d-37w1d），平均潜伏期为15.8周，明显长于文献和我们自己的数据(经皮FLP10.2的平均潜伏期,95%CI9.9-10.5).此外，所有病例在分娩前都接受了医源性分娩，由于担心激光后TAPS，仅在34周之前交货。
结论：此例病例系列开腹FLP经羊膜缝合，无自发性早产病例,且手术至分娩的潜伏期比预期长.有必要进行更大规模的研究来研究这种方法。
方法：回顾性系列双胎输血综合征（TTTS）或双胎贫血-红细胞增多症（TAPS）病例在2个胎儿中心接受治疗，于2017年9月至2023年1月接受了FLP产妇剖腹手术。我们记录了术前和手术特征，以及妊娠和新生儿结局。
结果：在研究期间，对9例FLP患者进行了剖腹手术。在怀孕期间，有两个被排除在先前的经皮FLP之外。其余7例使用产妇剖腹手术进行羊膜缝合，并在超声引导下确认正确的缝合位置，所有手术均通过锋利的单根10FCheck-Flo®套管进行。手术时的平均胎龄（GA）为19.1周（范围16w4d-23w3d），分娩时平均GA为35.0周（范围32w0d-37w1d），平均潜伏期为15.8周，明显长于文献和我们自己的数据(经皮FLP10.2的平均潜伏期,95%CI9.9-10.5).此外，所有病例在分娩前都接受了医源性分娩，由于担心激光后TAPS，仅在34周之前交货。
结论：此例病例系列开腹FLP经羊膜缝合，无自发性早产病例,且手术至分娩的潜伏期比预期长.有必要进行更大规模的研究来研究这种方法。
