Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome

Fetoscopic laser surgery, also called fetoscopic laser photocoagulation, is the most effective treatment for severe cases of TTTS. The goal of this procedure is to separate the twins’ blood circulation by closing the abnormal blood vessel connections on the placenta. This helps balance blood flow between the twins and allows each baby to grow independently.

During the procedure, doctors insert a small camera called a fetoscope into the mother’s uterus through a tiny incision in her abdomen. Guided by ultrasound imaging, the surgeon carefully examines the shared placenta to identify the blood vessel connections between the twins. Then, using a special laser fiber passed through the fetoscope, the surgeon seals off these connecting vessels so that blood no longer flows unevenly from one twin to the other. After the laser treatment, the surgeon may also drain excess amniotic fluid if one twin has developed too much. The procedure typically lasts one to two hours and is done under local or regional anesthesia.

Following surgery, the mother is monitored closely with regular ultrasounds to check both babies’ growth, heart function, and amniotic fluid levels. Most patients stay in the hospital for a short period before continuing the pregnancy under close observation.

Fetoscopic laser surgery has greatly improved outcomes for twins affected by TTTS. Before this technique, survival rates for both twins were very low. Today, more than 80% of pregnancies treated with fetoscopic laser surgery result in at least one surviving twin, and about 60% lead to both twins surviving. The procedure also reduces the risk of long-term complications such as brain injury or heart failure in the twins.

In summary, fetoscopic surgery is a life-saving, minimally invasive technique that gives hope to families facing TTTS. By restoring balance in blood flow between twins, it allows both babies a greater chance at a healthy start to life.

by Ariela Okanta at Incisionary

APA References

Fetal Laser and Surgery - Society for Maternal-Fetal Medicine. (2017). Smfm.org. https://www.smfm.org/news/fetal-laser-and-surgery

Fetoscopic Laser Surgery. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/gynecology-obstetrics/specialty-areas/fetal-therapy/fetal-interventions-procedures/fetoscopic-laser-surgery

Laser Therapy for twin-twin Transfusion Syndrome Offers Best Outcomes - Mayo Clinic. (2021, March 19). Www.mayoclinic.org. https://www.mayoclinic.org/medical-professionals/obstetrics-gynecology/news/laser-therapy-for-twin-twin-transfusion-syndrome-offers-best-outcomes/mac-20509521

Philadelphia, T. C. H. of. (2021, May 26). Fetoscopic Laser Surgery for TTTS. Www.chop.edu. https://www.chop.edu/treatments/fetoscopic-laser-surgery-ttts

Sago, H., Ishii, K., Sugibayashi, R., Ozawa, K., Sumie, M., & Wada, S. (2018). Fetoscopic laser photocoagulation for twin–twin transfusion syndrome. The Journal of Obstetrics and Gynaecology Research, 44(5), 831–839. https://doi.org/10.1111/jog.13600

TTTS Fetoscopic Laser Surgery | Children’s Hospital Colorado. (2019). Childrenscolorado.org. https://www.childrenscolorado.org/doctors-and-departments/departments/colorado-fetal-care-center/services/fetoscopic-laser-surgery/

Twin-to-Twin Transfusion Syndrome | Advocate Children’s Hospital. (2025). Advocate Children’s Hospital . https://www.advocatechildrenshospital.com/services/fetal-care/treatments-and-services/twin-to-twin-transfusion-syndrome-surgery