scholarly journals Comparison of Solomon technique with selective laser ablation for twin-twin transfusion syndrome: a systematic review

2015 ◽  
Vol 46 (5) ◽  
pp. 526-533 ◽  
Author(s):  
R. K. Dhillon ◽  
S. C. Hillman ◽  
R. Pounds ◽  
R. K. Morris ◽  
M. D. Kilby
Keyword(s):  
Systematic Review ◽  
Laser Ablation ◽  
Solomon Technique

scholarly journals Laser Treatment of Twin–to–Twin Transfusion Syndrome

2016 ◽  
Vol 19 (3) ◽  
pp. 197-206 ◽  
Author(s):  
Rubén A. Quintero ◽  
Eftichia Kontopoulos ◽  
Ramen H. Chmait
Keyword(s):  
Laser Ablation ◽  
Laser Surgery ◽  
Surgical Techniques ◽  
Placental Tissue ◽  
Successful Completion ◽  
Surgical Performance ◽  
Potential Source ◽  
And Performance ◽  
Solomon Technique ◽  
Selective Technique

Objective: Laser ablation of all placental vascular anastomoses is the optimal treatment for twin–twin transfusion syndrome (TTTS). However, two important controversies are apparent in the literature: (a) a gap between concept and performance, and (b) controversy regarding whether all the anastomoses can be identified endoscopically and whether blind lasering of healthy placenta is justified. The purpose of this article is: (a) to address the potential source of the gap between concept and performance by analyzing the fundamental steps needed to successfully accomplish the surgery, and (b) to discuss the resulting competency benchmarks reported with the different surgical techniques. Materials and Methods: Laser surgery for TTTS can be broken down into two fundamental steps: (1) endoscopic identification of the placental vascular anastomoses, (2) laser ablation of the anastomoses. The two steps are not synonymous: (a) regarding the endoscopic identification of the anastomoses, the non-selective technique is based upon lasering all vessels crossing the dividing membrane, whether anastomotic or not. The selective technique identifies and lasers only placental vascular anastomoses. The Solomon technique is based on the theory that not all anastomoses are endoscopically visible and thus involves lasering healthy areas of the placenta between lasered anastomoses, (b) regarding the actual laser ablation of the anastomoses, successful completion of the surgery (i.e., lasering all the anastomoses) can be measured by the rate of persistent or reverse TTTS (PRTTTS) and how often a selective technique can be achieved. Articles representing the different techniques are discussed. Results: The non-selective technique is associated with the lowest double survival rate (35%), compared with 60–75% of the Solomon or the Quintero selective techniques. The Solomon technique is associated with a 20% rate of residual patent placental vascular anastomoses, compared to 3.5–5% for the selective technique (p < .05). Both the Solomon and the selective technique are associated with a 1% risk of PRTTTS. Adequate placental assessment is highest with the selective technique (99%) compared with the Solomon (80%) or the ‘standard’ (60%) techniques (p < .05). A surgical performance index is proposed. Conclusion: The Quintero selective technique was associated with the highest rate of successful ablation and lowest rate of PRTTTS. The Solomon technique represents a historical backward movement in the identification of placental vascular anastomoses and is associated with higher rate of residual patent vascular communications. The reported outcomes of the Quintero selective technique do not lend support to the existence of invisible anastomoses or justify lasering healthy placental tissue.

scholarly journals 728 A Systematic Review of The Efficacy and Safety of Outpatient Bladder Tumour Ablation

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Malde ◽  
S Grover ◽  
S Raj ◽  
C Yuan ◽  
R Nair ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laser Ablation ◽  
General Anaesthesia ◽  
Cochrane Library ◽  
Progression Rate ◽  
Low Grade ◽  
Complication Rates ◽  
Patient Counselling ◽  
Quality Of Evidence

Abstract Introduction The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC. Method The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively. Results From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low. Conclusions This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.

scholarly journals EP24.09: Selective laser ablation followed by a delayed Solomon technique for Twin–twin transfusion syndrome may improve dual survival

2019 ◽  
Vol 54 (S1) ◽  
pp. 394-394
Author(s):  
C.L. Dinglas ◽  
J. Davis ◽  
C. Heiselman ◽  
M. Chavez ◽  
A. Vintzileos
Keyword(s):  
Laser Ablation ◽  
Solomon Technique

scholarly journals Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using ‘Solomon technique’

2013 ◽  
pp. n/a-n/a ◽  
Author(s):  
R. Ruano ◽  
C. Rodo ◽  
J. L. Peiro ◽  
A. A. Shamshirsaz ◽  
S. Haeri ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Solomon Technique

scholarly journals Commonly Used Endovenous Laser Ablation (EVLA) Parameters Do Not Influence Efficacy: Results of a Systematic Review and Meta-Analysis

2019 ◽  
Vol 58 (2) ◽  
pp. 230-242 ◽  
Author(s):  
Wendy S.J. Malskat ◽  
Lotte K. Engels ◽  
Loes M. Hollestein ◽  
Tamar Nijsten ◽  
Renate R. van den Bos
Keyword(s):  
Systematic Review ◽  
Laser Ablation ◽  
Meta Analysis ◽  
Endovenous Laser Ablation
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