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 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 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 Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment

2021 ◽  
Vol 48 ◽  
Author(s):  
THAMYLE MODA DE SANTANA REZENDE ◽  
VIKTORIA WEIHERMANN ◽  
CAMILA GIRARDI FACHIN ◽  
RAFAEL FREDERICO BRUNS ◽  
ANDRÉ IVAN BRADLEY SANTOS DIAS
Keyword(s):  
Laser Ablation ◽  
Gold Standard ◽  
Neonatal Period ◽  
Positive Impact ◽  
Fetal Surgery ◽  
Stage Iv ◽  
University Hospital ◽  
Post Procedure ◽  
Solomon Technique ◽  
Intrauterine Treatment

ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero’s staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero’s staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.

Fetoscopic laser ablation therapy in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome treated at a single centre over 10 years: a retrospective study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Anna Fichera ◽  
Vita Valentina Azzaretto ◽  
Nicola Fratelli ◽  
Sara Mancino ◽  
Daria Marella ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Laser Ablation ◽  
Survival Rates ◽  
Stage Iv ◽  
Final Analysis ◽  
Single Centre ◽  
Ablation Therapy ◽  
Solomon Technique ◽  
Twin Pregnancies ◽  
Over Time

Abstract Objectives To review experience with fetoscopic laser ablation of placental anastomoses to treat monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in a single centre over a ten-year period. Methods A retrospective study on 142 MCDA twin pregnancies complicates by TTTS treated with equatorial laser ablation of placental anastomoses (2008–2018). Solomon technique was also applied after 2013. Survival rates, neonatal outcome, intraoperative and post-laser complications were recorded, and prognostic factors analysed. Results A total of 133 cases were included in the final analysis; 41 patients were at stage II (30.8%), 73 were at stage III (62.9%), while only 12 (9%) at stage I and two patients (1.7%) at stage IV. Solomon technique was applied in 39 cases (29.3%). Survival of both twins was 51.1% (68/133), of a single twin 20.3% (27/133), and of at least one 71.5% (95/133), with an overall survival of 61.3% (163/266). TAPS and recurrent TTTS occurred in 8 (6%) and 15 (11.3%) patients. Survival of both fetuses increased over time (44.6 vs. 57.3%). A posterior placenta (p<0.003) and the use of the Solomon technique (p<0.02) were more frequent in cases with survival of both fetuses, while TTTS recurrence was significantly associated to the loss of one or two fetuses (p<0.01). Such associations were confirmed at logistic regression analysis. Conclusions Survival of both twins can improve over time and seems to be favourably associated with a placenta in the posterior location and the use of the Solomon technique.

Observations on the growth of YBa2Cu3O7-δ thin films on MgO by pulsed-laser ablation

1991 ◽  
Vol 49 ◽  
pp. 1068-1069
Author(s):  
M. Grant Norton ◽  
C. Barry Carter
Keyword(s):  
Thin Film ◽  
Thin Films ◽  
Laser Ablation ◽  
Substrate Surface ◽  
Pulsed Laser ◽  
Pulsed Laser Ablation ◽  
Thin Film Deposition ◽  
Film Deposition ◽  
Laser Ablation Process ◽  
Deposition Parameters

Pulsed-laser ablation has been widely used to produce high-quality thin films of YBa2Cu3O7-δ on a range of substrate materials. The nonequilibrium nature of the process allows congruent deposition of oxides with complex stoichiometrics. In the high power density regime produced by the UV excimer lasers the ablated species includes a mixture of neutral atoms, molecules and ions. All these species play an important role in thin-film deposition. However, changes in the deposition parameters have been shown to affect the microstructure of thin YBa2Cu3O7-δ films. The formation of metastable configurations is possible because at the low substrate temperatures used, only shortrange rearrangement on the substrate surface can occur. The parameters associated directly with the laser ablation process, those determining the nature of the process, e g. thermal or nonthermal volatilization, have been classified as ‘primary parameters'. Other parameters may also affect the microstructure of the thin film. In this paper, the effects of these ‘secondary parameters' on the microstructure of YBa2Cu3O7-δ films will be discussed. Examples of 'secondary parameters' include the substrate temperature and the oxygen partial pressure during deposition.

153: Successful Gold Nanoshell Assisted Laser Ablation of Prostate Carcinoma in Vitro

2007 ◽  
Vol 177 (4S) ◽  
pp. 52-52
Author(s):  
Joshua M. Stem ◽  
Jer-Tsang Hsieh ◽  
Sangtae Park ◽  
Yair Lotan ◽  
Jeffrey A. Cadeddu
Keyword(s):  
Laser Ablation ◽  
Prostate Carcinoma ◽  
Gold Nanoshell
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