Since TTTS does not exist in identical monochorionic (MC) twins without the connecting placental blood vessels, it seems reasonable to find a way to separate the twins’ blood streams by destroying the connections. The availability of surgical lasers in the early 1980’s led this innovative option, and the first fetoscopic laser occlusion of the connecting vessels was performed in 1988 by Dr. Julian E. De Lia at the University of Utah on a couple from Great Falls, Montana. By linking the laser to fetoscopy (the insertion of a tiny telescope into the pregnant uterus), doctors are able to see and destroy all the connecting vessels. This operation is the only TTTS treatment that can ‘disconnect’ the twins and stop both the chronic transfusion of blood from the donor to the recipient, and the acute or sudden transfusion should one baby pass away or become suddenly ill.
This laser surgery is now performed in centers throughout the world as more and more doctors are convinced that this will lead to the best outcomes. To the best of our knowledge, placental laser surgery results in the highest numbers of healthy survivors in those patients with previable (i.e., less than 25 weeks’ gestation) onset or diagnosis of TTTS. Reports on this therapy currently indicate the following: 85-90% survival of at least one twin, 70-75% overall twin survival, 2% or less significant handicap rates in the survivors, and a treatment to delivery average interval of close to 10 weeks. The results may vary in different centers, and this may reflect different levels of experience or the actual surgical techniques used. The procedure involves general anesthesia for the mother, and the surgical complication rates also vary in different centers. These must be discussed with the individual doctors performing the surgery.