Selective Fetoscopic Laser Photocoagulation (SFLP)

Fetoscopic laser photocoagulation is a minimally invasive surgical procedure that uses a small camera (fetoscope) to locate abnormal blood vessel connections in the placenta and seal them using laser energy.

Fetoscopic laser photocoagulation is the preferred method of treatment for certain severe cases of twin-twin transfusion syndrome. The procedure stops the transfer of blood between fetuses, often halting the progression of TTTS. Thorough evaluation, which may include include ultrasound, fetal echocardiogram and amniocentesis, will be conducted before deciding if fetoscopic laser photocoagulation is an appropriate option.

Generally, the fetus should be between 16 and 26 weeks gestation with no other significant anomalies, and the mother should be healthy.

About the procedure

Fetoscopic laser photocoagulation is done in the hospital, usually on an inpatient basis. The mother is given IV sedation and local anesthesia. An epidural may also be given, depending on the location of the placenta. Medicine to prevent labor is administered.

Our surgeon makes a small incision in the mother’s abdomen, and a trocar (tiny metal tube) is inserted into the uterus. The fetoscope is passed through the trocar to examine and map the blood vessel connections on the surface of the placenta shared by the twins. The image is viewed on a large computer monitor. Ultrasound is used to continuously monitor the procedure.

A laser is used to seal abnormal blood vessels and disconnect them permanently, and the surgeon drains excess amniotic fluid through the trocar before removing it. After sealing the blood vessels between the twins, our surgeons laser a line between the connections in order to coagulate even smaller vessels from one side to the other. This process is called solomonization. A recent study published by our group showed that this procedure is responsible for a better survival rate of both twins (84.6%).

After the procedure, the mother is given medicine to prevent premature labor. Although each case is different, most patients remain in the hospital for one day.

Five days after surgery, ultrasound and fetal echocardiography are performed to evaluate the condition of the fetuses.

Although every procedure has risks, the chance of serious side effects with this procedure are rare. Possible problems include premature labor and harm to the fetus. During your evaluation, your doctors at the Texas Children’s Fetal Center will provide a detailed review of your babies' condition and treatment options.