{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T08:53:52Z","timestamp":1784364832317,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The optimal outcome after fetoscopic laser surgery (FLS) for twin\u2013twin transfusion syndrome (TTTS) depends on the successful ablation of all placental anastomoses. The objective of this study was to determine the incidence of and risk factors for recurrent TTTS (rTTTS) or twin anemia\u2013polycythemia sequence (TAPS) after FLS, focusing on the impact of cannula diameter.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a secondary analysis of data collected prospectively at two centers from 666 consecutive patients undergoing FLS for TTTS. The main outcomes were rTTTS and TAPS following FLS. Variables assessed included gestational age at intervention, stage of disease, recipient maximum vertical pocket, anterior placenta, number of anastomoses ablated, cannula diameter\/operative scopes and use of the Solomon technique. Cannula diameter and corresponding scopes used were as follows: 8 Fr and 1.3\u2009mm\/0\u00b0; 9 Fr and 2.7\u2009mm\/0\u00b0; 10 Fr and 3\u2009mm\/0\u00b0; or 12 Fr and 3.3\u20133.7\u2009mm\/30\u201370\u00b0. Cannula diameter was used as a surrogate for scopes during analysis. Multivariate logistic regression analysis was performed to identify risk factors associated with rTTTS or TAPS after FLS; \u2018center\u2019 was considered an independent variable to account for variations in practice. In a nested cohort of pregnancies in which both fetuses survived, placental dye injection was performed in 315 placentae. Multivariate logistic regression analysis was performed to evaluate variables associated with the presence of residual anastomoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>rTTTS or TAPS occurred in 61 (9%) cases following FLS (rTTTS in eight (1%) and TAPS in 53 (8%)). Factors associated significantly with the risk of rTTTS\/TAPS on multivariate analysis were cannula diameter (when an 8\u2010Fr, 9\u2010Fr, 10\u2010Fr or 12\u2010Fr cannula was used, there was rTTTS\/TAPS in 24%, 13%, 2% or 0.8% of cases, respectively (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001)) and use of the Solomon technique (rTTTS\/TAPS occurred in 4.2% of those in which it was used <jats:italic>vs<\/jats:italic> 18.1% in those in which it was not (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001)). Only use of the Solomon technique was associated significantly with no residual anastomoses found after delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Following FLS for TTTS, a lower incidence of rTTTS\/TAPS was seen when the Solomon technique was used, as well as when a 10\u2010Fr or 12\u2010Fr cannula was used. A lower complication rate may be due to the use of a scope with better optics during placental mapping. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.18904","type":"journal-article","created":{"date-parts":[[2017,9,19]],"date-time":"2017-09-19T11:46:46Z","timestamp":1505821606000},"page":"744-749","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of cannula size on recurrent twin\u2013twin transfusion syndrome and twin anemia\u2013polycythemia sequence after fetoscopic laser surgery"],"prefix":"10.1002","volume":"52","author":[{"given":"R.","family":"Donepudi","sequence":"first","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2274-8357","authenticated-orcid":false,"given":"J.","family":"Akkermans","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Mann","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. J.","family":"Klumper","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. M.","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. J.","family":"Moise Jr","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bebbington","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Papanna","sequence":"additional","affiliation":[{"name":"The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School University of Texas Health Science Center at Houston  TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.069"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62419-8"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2491"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.05.009"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.050"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.062"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.05.012"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000346413"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000304512"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11105"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441915"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.02021.x"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7495"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000106344"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5283"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2803"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767050903128618"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000858"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016925309136722"},{"key":"e_1_2_5_23_1","article-title":"Accurate and simple evaluation of vascular anastomoses in monochorionic placenta using colored dye","volume":"55","author":"Lopriore E","year":"2011","journal-title":"J Vis Exp"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.05.036"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.906"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318195873e"}],"container-title":["Ultrasound in Obstetrics &amp; 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