Laser therapy
Fetoscopic laser therapy for TTTS performed percutaneously
before 26 weeks of gestation is a minimally
invasive treatment with few maternal complications,
with premature rupture of membranes becoming
the main source of neonatal complications [17].
It has been recognized that laser surgery for TTTS
should be available in fetal medicine units that
are managing at least 20 cases per year [13].
Sonography is very important before, during, and
after this procedure. Before the procedure, you
have to locate the position of the placenta, the
position of the fetuses, the amount of amniotic fluid,
and the ideal position for insertion of the fetoscope.
A good evaluation is crucial for a successful operation.
The insertion of the fetoscope is usually not
difficult in mainly posterior placenta (Fig. 1); you
just need to choose the site of entry directly into
the sac of the recipient. The risk of septostomy is
low in such cases. But in cases of mainly anterior
placenta (Fig. 2), to choose an ideal site for entry is
not always easy. In cases where the free space for
entry is located near the sac of the donor, the risk
of septostomy is high. During operation, you have
to identify whether there are uterine wall vessels