Fetoscopic laser coagulation (FLC) has been shown to improve survival and reduce neurological morbidity in twin to twin transfusion syndrome (TTTS). Varying techniques for ablation exist with “Solomonisation” being a selective laser coagulation of placental vessels (SLCPV) with the addition of a subsequent surface coagulation of the placenta between the ablated vessels. The hypothesis is that the Solomon technique reduces the recurrence of TTTS (TOPS) and twin anaemia-polycythaemia sequence (TAPS), both highly morbid complications.Methods
Protocol according to PICOS criteria. Electronic searches of MEDLINE, Embase, Cinahl, Cochrane and grey literature. Inclusion criteria were a pregnancy undergoing FLC for TTTS, intervention sequential laser compared to Solomon technique. Primary outcomes were perinatal survival, incidence of recurrent TTTS and/or TAPS. Secondary outcomes included maternal and neonatal morbidity outcomes. Included studies could be randomised controlled trials (RCT) or observational. Quality assessment was performed using the appropriate assessment criteria (CASP, STROBE). Results are reported as odds ratios (OR) with 95% confidence intervals.Results
There were 3 studies, one RCT and two observational, including 523 monochroionic twin pregnancies. Meta-analysis could not be performed for perinatal survival due to different outcome measures being used thus data from each of the studies will be presented. For recurrence of TTTS with Solomon technique there was a significant reduction, OR 0.30 (95% CI 0.11–0.81) p = 0.02. For TAPS there was also a significant reduction, OR 0.22 (95% CI 0.09–0.53) p = 0.001.Conclusion
The Solomon technique significantly reduces the complications of FLC of TOPS and TAPS.