Influence of experience, case load, and stage distribution on outcome of endoscopic laser surgery for TTTS--a review

Prenatal Diagnosis
Shair AhmedS R Carr

Abstract

Survival (> or =1 twin) after laser surgery for patients with twin-to-twin transfusion syndrome (TTTS) ranges from 65 to 93%. However, most studies are noncontrolled and retrospective, and have included a limited number of patients. The aim of this study was to perform a systematic review of outcomes after laser surgery in patients with TTTS. We conducted database and manual searches of reference lists and pertinent journals published between 1995 and 2009 that report outcomes of laser surgery in patients with TTTS. Two authors performed the search independently of each other. There exist only two randomized controlled trials, each with fewer than 80 patients having undergone laser surgery. Uncontrolled and retrospective series were therefore considered as well. Studies had to report sufficient information on inclusive dates, stage distribution, overall neonatal survival, and neonatal survival of at least one twin. Of the 486 studies identified, we considered 19 studies. For each series, 95% confidence intervals (CI) were calculated. Survival was plotted against the date of publication, number of patients/series, gestational age at delivery, and proportion of advanced cases. Univariate analysis was performed to detect significa...Continue Reading

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