{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:58:45Z","timestamp":1759564725428,"version":"3.37.3"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Twin reversed arterial perfusion sequence is a rare complication of monochorionic multifetal pregnancies. In this syndrome, the acardiac twin has a nonfunctional heart, while the other twin, the pump twin, has normal development. The pump twin perfuses the acardiac twin and is therefore at risk for cardiac decompensation. In monoamniotic cases, the normal co-twin is also at risk of sudden death due to cord entanglement. Treatment consists of coagulation and transection of the acardiac\u2019s umbilical cord. We report the first intrauterine use in pregnancy of a Ho:yttrium aluminum garnet laser to safely and successfully transect the umbilical cord after Nd:yttrium aluminum garnet coagulation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 30-year-old Caucasian woman was referred to our fetal\u2013maternal medicine unit at 9\u00a0weeks gestation with a monochorionic\u2013monoamniotic twin pregnancy complicated by an acardiac twin. After counseling, she opted for an elective intervention to minimize the risks to the pump twin. At 16 weeks, fetoscopy was performed using a single 2-mm entry port. Through this port, a 1.0-mm fetoscope and a 0.365-mm laser fiber were introduced. Under fetoscopic sight and ultrasound (Doppler) guidance, the umbilical cord of the acardiac twin was first coagulated by laser energy using a Nd:yttrium aluminum garnet laser and then, using the same fiber, transected using a Ho:yttrium aluminum garnet laser. The patient underwent cesarean section at 38 weeks and delivered a healthy baby.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We present the first report on intrauterine use of an Ho:yttrium aluminum garnet laser in human pregnancy. Ho:yttrium aluminum garnet laser energy can be successfully and safely used for umbilical cord transection and carries fewer risks than other methods of transection.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-022-03360-4","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T23:02:28Z","timestamp":1649199748000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Use of holmium laser for umbilical cord transection in a monoamniotic pregnancy threatened by an acardiac co-twin: a case report"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2336-6799","authenticated-orcid":false,"given":"Anouk M.","family":"van der Schot","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Jeltes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joris","family":"van Drongelen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory","family":"Woiski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Sikkel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank P. H. A.","family":"Vandenbussche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"issue":"3","key":"3360_CR1","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/0002-9378(90)91094-S","volume":"163","author":"TR Moore","year":"1990","unstructured":"Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol. 1990;163(3):907\u201312.","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"3360_CR2","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1002\/tera.1420500306","volume":"50","author":"MG Healey","year":"1994","unstructured":"Healey MG. Acardia: predictive risk factors for the co-twin\u2019s survival. Teratology. 1994;50(3):205\u201313.","journal-title":"Teratology"},{"issue":"3","key":"3360_CR3","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.ajog.2010.04.018","volume":"203","author":"L Lewi","year":"2010","unstructured":"Lewi L, Valencia C, Gonzalez E, Deprest J, Nicolaides KH. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol. 2010;203(3):213-e1.","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"3360_CR4","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1159\/000111591","volume":"23","author":"JM Middeldorp","year":"2008","unstructured":"Middeldorp JM, Klumper FJ, Oepkes D, Lopriore E, Kanhai HH, Vandenbussche FP. Selective feticide in monoamniotic twin pregnancies by umbilical cord occlusion and transection. Fetal Diagn Ther. 2008;23(2):121\u20135.","journal-title":"Fetal Diagn Ther"},{"issue":"4","key":"3360_CR5","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1002\/uog.224","volume":"22","author":"TY Tan","year":"2003","unstructured":"Tan TY, Sepulveda W. Acardiac twin: a systematic review of minimally invasive treatment modalities. Ultrasound Obstet Gynecol. 2003;22(4):409\u201319.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"3","key":"3360_CR6","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1159\/000021001","volume":"15","author":"JB Lopoo","year":"2000","unstructured":"Lopoo JB, Paek BW, Maichin GA, Lipshutz GS, Jennings RW, Farmer DL, Sandberg PL, Feldstein VA, Filly RA, Farrell JA, Harrison MR. Cord ultrasonic transection procedure for selective termination of a monochorionic twin. Fetal Diagn Ther. 2000;15(3):177\u20139.","journal-title":"Fetal Diagn Ther"},{"issue":"9","key":"3360_CR7","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1111\/jog.12720","volume":"41","author":"M Takano","year":"2015","unstructured":"Takano M, Murata S, Fujiwara M, Hirata H, Nakata M. Experience of fetoscopic laser photocoagulation and cord transection for twin-reversed arterial perfusion sequence. J Obstet Gynaecol Res. 2015;41(9):1326\u20139.","journal-title":"J Obstet Gynaecol Res"},{"issue":"4","key":"3360_CR8","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1159\/000436961","volume":"40","author":"NB Kunzier","year":"2016","unstructured":"Kunzier NB, Allaf B, Chavez MR, Abenanti-Richmond D, Vintzileos AM. Disentanglement of discordant monochorionic-monoamniotic twins in a triplet pregnancy: an innovative approach utilizing fetoscopic laser coagulation with micro-laparoscopic scissor dissection. Fetal Diagn Ther. 2016;40(4):303\u20135.","journal-title":"Fetal Diagn Ther"},{"issue":"3","key":"3360_CR9","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00345-007-0184-5","volume":"25","author":"HO Teichmann","year":"2007","unstructured":"Teichmann HO, Herrmann TR, Bach T. Technical aspects of lasers in urology. World J Urol. 2007;25(3):221\u20135.","journal-title":"World J Urol"},{"issue":"4","key":"3360_CR10","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s00345-014-1395-1","volume":"33","author":"P Kronenberg","year":"2015","unstructured":"Kronenberg P, Traxer O. Update on lasers in urology 2014: current assessment on holmium: yttrium\u2013aluminum\u2013garnet (Ho: YAG) laser lithotripter settings and laser fibers. World J Urol. 2015;33(4):463\u20139.","journal-title":"World J Urol"},{"issue":"3","key":"3360_CR11","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1089\/end.2017.0835","volume":"32","author":"E Emiliani","year":"2018","unstructured":"Emiliani E, Talso M, Haddad M, Pouliquen C, Derman J, Cote JF, Doizi S, Millan F, Berthe L, Audouin M, Traxer O. The true ablation effect of holmium YAG laser on soft tissue. J Endourol. 2018;32(3):230\u20135.","journal-title":"J Endourol"},{"issue":"8","key":"3360_CR12","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1089\/089277901753205825","volume":"15","author":"SJ Karlsen","year":"2001","unstructured":"Karlsen SJ, Bull-Njaa T, Krokstad A. Measurement of sound emission by endoscopic lithotripters: an in vitro study and theoretical estimation of risk of hearing loss in a fetus. J Endourol. 2001;15(8):821\u20136.","journal-title":"J Endourol"},{"issue":"2","key":"3360_CR13","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/S0002-9378(00)70221-3","volume":"182","author":"JA Deprest","year":"2000","unstructured":"Deprest JA, Audibert F, Van Schoubroeck D, Hecher K, Mahieu-Caputo D. Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy. Am J Obstet Gynecol. 2000;182(2):340\u20135.","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"3360_CR14","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1080\/jmf.14.4.277.278","volume":"14","author":"C Bermudez","year":"2003","unstructured":"Bermudez C, Tejada P, Gonzalez F, Perez-Wulff J. Umbilical cord transection in twin-reverse arterial perfusion syndrome with the use of a coaxial bipolar electrode (Versapoint (R)). J Maternal-Fetal Neonatal Med. 2003;14(4):277.","journal-title":"J Maternal-Fetal Neonatal Med"},{"issue":"6","key":"3360_CR15","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1002\/uog.18904","volume":"52","author":"R Donepudi","year":"2018","unstructured":"Donepudi R, Akkermans J, Mann L, Klumper FJ, Middeldorp JM, Lopriore E, Moise KJ Jr, Bebbington M, Johnson A, Oepkes D, Papanna R. Impact of cannula size on recurrent twin\u2013twin transfusion syndrome and twin anemia\u2013polycythemia sequence after fetoscopic laser surgery. Ultrasound Obstet Gynecol. 2018;52(6):744\u20139.","journal-title":"Ultrasound Obstet Gynecol"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-022-03360-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-022-03360-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-022-03360-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T23:02:30Z","timestamp":1649199750000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-022-03360-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["3360"],"URL":"https:\/\/doi.org\/10.1186\/s13256-022-03360-4","relation":{},"ISSN":["1752-1947"],"issn-type":[{"type":"electronic","value":"1752-1947"}],"subject":[],"published":{"date-parts":[[2022,4,6]]},"assertion":[{"value":"15 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written Institutional Review Board (IRB) approval from our institution has been granted for these types of fetal therapy, and oral consent from the parents to participate was granted.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient to publish this case report\u00a0and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"136"}}