The effect of surgeon experience on outcomes of fetoscopic laser coagulation of placental anastomoses in twin-to-twin transfusion syndrome


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Abstract

Relevance. Fetoscopic laser coagulation (FLC) of placental anastomoses is the only pathogenetically oriented treatment of twin-to-twin transfusion syndrome (TTTS). Aim. To investigate the effect of the learning curve for TTTS on treatment outcomes and the incidence of postoperative complications. Material and methods. This retrospective study included 126 patients with monochorionic diamniotic twins who underwent fetoscopic laser coagulation of placental anastomoses for TTTS at the V.I. Kulakov NMRC for OG&P in 2014-2019. The patients were divided into three equal groups of 42 women each. Groups 1, 2, and 3 included pregnant women who underwent FLC in 2014-2016, 2017-2018, and 2018-2019, respectively. The study investigated the effect of the learning curve on fetal survival and complication rates. Statistical analysis was performed using the D’Agostino-Pearson test, the Mann-Whitney U-test, and the Kruskal-Wallis test. Differences were considered statistically significant atp <0.05. Results. Increasing surgeon caseload for FLC was associated with higher overall (from 61.9% to 88.1%) and both twins’ survival rates (from 38.1% to 59.5%). Postoperative complication rates reduced from 64.3% to 52.4%. The incidence of neonatal morbidity and mortality decreased along with an increasing number of FLCs performed. We achieved satisfactory FLC results for overall survival (at least 73%) after performing 34 procedures, and 80 procedures for the survival of both twins (at least 55%). Conclusion. The accumulation of experience and concentration of fetal surgery at a high-volume provider contributes to better overall and both twins’ survival with a concomitant reduction in the incidence of postoperative complications. FLC and other in utero surgical procedures should be concentrated at highly specialized high-volume centers with high patients’ flow.

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About the authors

Kristina A. Gladkova

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: k_gladkova@oparina4.ru
M.D., Ph.D., Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Head of the 1st Obstetric Department of Pathology of Pregnancy

Kirill V. Kostyukov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: kostyukov_k@yahoo.com
M.D., Ph.D., Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Physician at the Unit of Functional and Ultrasound Diagnostics, Department of Diagnostic Imaging

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