scholarly journals OC08.08: Effects of complete and incomplete Solomon technique on perinatal outcomes in fetoscopic laser surgery

2021 ◽  
Vol 58 (S1) ◽  
pp. 27-28
Author(s):  
T. Sarac Sivrikoz ◽  
I. Kalelioglu ◽  
C. Kunt Isguder ◽  
L. Uygur ◽  
R. Has
Keyword(s):  
Laser Surgery ◽  
Perinatal Outcomes ◽  
Solomon Technique

278: Incidental septostomy after laser surgery for twin-twin transfusion syndrome: perinatal outcomes and antenatal management

2017 ◽  
Vol 216 (1) ◽  
pp. S170
Author(s):  
Brian Gordon ◽  
Andrew H. Chon ◽  
Lisa M. Korst ◽  
Arlyn Llanes ◽  
David A. Miller ◽  
...  
Keyword(s):  
Laser Surgery ◽  
Perinatal Outcomes ◽  
Antenatal Management

Incidental Septostomy after Laser Surgery for Twin-Twin Transfusion Syndrome: Perinatal Outcomes and Antenatal Management

2017 ◽  
Vol 44 (4) ◽  
pp. 285-290 ◽  
Author(s):  
Brian J. Gordon ◽  
Andrew H. Chon ◽  
Lisa M. Korst ◽  
Arlyn Llanes ◽  
David A. Miller ◽  
...  
Keyword(s):  
Laser Surgery ◽  
Perinatal Outcomes ◽  
Antenatal Management

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.

Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

2021 ◽  
Vol 24 (1) ◽  
pp. 42-48
Author(s):  
Seiji Kanazawa ◽  
Katsusuke Ozawa ◽  
Jin Muromoto ◽  
Rika Sugibayashi ◽  
Yuka Wada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Laser Surgery ◽  
Placental Abruption ◽  
Laser Energy ◽  
Significant Risk ◽  
Incidence Rates ◽  
Risk Profiling ◽  
Perinatal Management ◽  
Solomon Technique ◽  
Selective Technique

AbstractWe evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. The incidence rates of recurrent TTTS (Solomon vs. selective: 0% vs. .9%, p = .510) and twin anemia–polycythemia sequence (.6% vs. .4%, p = .670) were very low in both groups. The incidence rates of placental abruption (Solomon vs. selective: 10.7% vs. 3.5%, p = .007) and preterm premature rupture of the membranes (pPROM) with subsequent delivery before 32 weeks (20.2% vs. 7.1%, p < .001) were higher in the Solomon group. The median birth recipient weight was significantly smaller in the Solomon group (1790 g vs. 1933 g, p = .049). The rate of survival of at least one twin was significantly higher in the Solomon group (98.2% vs. 93.8%, p = .046). The Solomon technique and total laser energy were significant risk factors for pPROM (odds ratio: 2.64, 1.07, 95% CI [1.32, 5.28], [1.01, 1.13], p = .006, p = .014, respectively). These findings suggest that the Solomon technique led to superior survival outcomes but increased risks of placental abruption, pPROM and fetal growth impairment. Total laser energy was associated with the occurrence of pPROM. Close attention to adverse events is required for perinatal management after FLS to treat TTTS using the Solomon technique.

scholarly journals Placental Abruption after Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: The Role of the Solomon Technique

2021 ◽  
pp. 1-7
Author(s):  
Patricia J.C. Knijnenburg ◽  
Enrico Lopriore ◽  
Yuchun Ge ◽  
Irene M. Scholl ◽  
Jeanine M.M. van Klink ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Laser Surgery ◽  
Placental Abruption ◽  
Group Versus ◽  
Cerebral Injury ◽  
Laser Technique ◽  
Solomon Technique ◽  
Gestational Age At Birth ◽  
Age At Birth

<b><i>Introduction:</i></b> Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a possible association between the Solomon laser technique and placental abruption. <b><i>Methods:</i></b> The objective of this study is to compare the rate of and to explore potential risk factors for placental abruption in TTTS treated with fetoscopic laser surgery according to the Selective and Solomon laser technique. We conducted a large retrospective cohort study of consecutive TTTS-cases treated with fetoscopic laser surgery in Shanghai, China, and Leiden, The Netherlands treated with either the Selective laser technique (Selective group) or Solomon laser technique (Solomon group). <b><i>Results:</i></b> The rate of placental abruption in the Selective group versus the Solomon group was 1.7% (5/289) and 3.4% (15/441), respectively (<i>p</i> = 0.184). No risk factors for placental abruption were identified. Placental abruption was associated with lower gestational age at birth (<i>p</i> = 0.003) and severe cerebral injury (<i>p</i> = 0.003). <b><i>Conclusion:</i></b> The prevalence of placental abruption in TTTS after fetoscopic laser surgery is low, although it appears higher than in the overall population. Placental abruption is associated with a lower gestational age at birth, which is associated with severe cerebral injury. The rate of placental abruption was not significantly increased with the use of the Solomon technique. Continued research of placental abruption in TTTS is necessary to determine why the rate is higher than in the overall population.

Rhinologic Laser Surgery

1983 ◽  
Vol 16 (4) ◽  
pp. 829-837
Author(s):  
George T. Simpson ◽  
Stanley M. Shapshay ◽  
Charles W. Vaughan
Keyword(s):  
Laser Surgery

Laryngeal Laser Surgery

1990 ◽  
Vol 23 (1) ◽  
pp. 49-66 ◽  
Author(s):  
Dennis M. Crockett ◽  
Bruce N. Reynolds
Keyword(s):  
Laser Surgery
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