Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Ultrasound Obstet Gynecol. 2015 Feb;45(2):168-74. doi: 10.1002/uog.14670. Epub 2014 Dec 18.
To evaluate differences between international fetal centers in their treatment of twin-twin transfusion syndrome (TTTS) by fetoscopic placental laser coagulation.
Fetal therapy centers worldwide were sent a web-based questionnaire. Participants were identified through networks and through scientific presentations and papers. Questions included physician and center demographics, treatment criteria, operative technique and instrumentation. Laser treatment was compared between low-volume (< 20 procedures/year) and high-volume (≥ 20 procedures/year) centers. Data were analyzed using descriptive statistics.
Of 106 fetal therapy specialists approached, 76 (72%) from 64 centers in 25 countries responded. Of these, 48% (31/64) of centers and 63% (48/76) of operators performed fewer than 20 laser procedures annually. Comparison of low- and high-volume centers showed differences in technique, gestational age limits for treatment and geography. High-volume centers more often used the Solomon technique and applied wider gestational age limits for treatment. Europe and Asia had more high-volume centers, whereas South America, the Middle East and Australia had mainly low-volume centers.
This survey revealed significant differences between fetal centers in several aspects of fetoscopic placental laser therapy for TTTS. Increasing awareness of TTTS, and of laser coagulation as its preferred treatment, will lead to an increase in centers offering this modality, especially in Asia, Africa, South America and the Middle East. Considering the rarity of TTTS and the relative complexity of the procedure, developing international guidelines for techniques, instrumentation and suggested minimum volumes per center may aid in optimizing perinatal outcome.
通过胎儿镜胎盘激光凝固术评估国际胎儿治疗中心在治疗双胎输血综合征（TTTS）方面的差异。
向全球胎儿治疗中心发送了一份网络问卷调查。通过网络和科学演讲及论文确定参与者。问题包括医生和中心的人口统计学资料、治疗标准、手术技术和仪器。将低容量（<20 例/年）和高容量（≥20 例/年）中心之间的激光治疗进行比较。使用描述性统计分析数据。
在 106 名接触的胎儿治疗专家中，来自 25 个国家的 64 个中心的 76 名（72%）做出了回应。其中，48%（31/64）的中心和 63%（48/76）的操作人员每年进行的激光手术少于 20 次。低容量和高容量中心之间的比较显示出技术、治疗的孕龄限制和地理位置方面的差异。高容量中心更常使用 Solomon 技术，并对治疗应用更宽的孕龄限制。欧洲和亚洲有更多的高容量中心，而南美洲、中东和澳大利亚则主要是低容量中心。
这项调查显示，胎儿中心在胎儿镜胎盘激光治疗 TTTS 的几个方面存在显著差异。提高对 TTTS 的认识，以及对激光凝固作为其首选治疗方法的认识，将导致更多中心提供这种模式，特别是在亚洲、非洲、南美洲和中东。考虑到 TTTS 的罕见性和手术的相对复杂性，制定关于技术、仪器和每个中心建议最小容量的国际指南可能有助于优化围产期结局。
