Laser Photocoagulation to Treat TTTS

Laser photocoagulation is an in-utero surgical treatment for Twin-to-Twin Transfusion Syndrome (TTTS).

It uses laser energy to close the blood vessels on the surface of the placenta so that the babies’ blood is no longer shared.

The procedure involves placing a very thin camera, called a fetoscope, into the uterus through a tiny 2-3mm incision in the skin. The fetoscope allows our surgeon to identify the small connecting blood vessels on the surface of the placenta.

Our surgeon then closes the blood vessels using laser energy from a small laser fiber through a channel on the fetoscope.

There may be as few as one or two connections, or they may be as many as 19 or 20, depending on the specific case.

The surgery is done in an operating room using spinal anesthesia, and typically takes 30-to-60 minutes.

Our Results

EvergreenHealth's Dr. Martin Walker and Dr. Bettina Paek are among the few physicians in the country trained in laser photocoagulation to treat twin-to-twin transfusion syndrome.

They have performed more than 460 procedures at EvergreenHealth, with the following results:

  • One twin survives in 90% of the cases
  • Both twins survive in 60-70% of the cases
  • Less than 5% of surviving twins have brain damage

What are the risks?

Possible risks include: chorioamnionitis, rupture of membranes, premature labor and miscarriage.

Maternal complications, such as abruption and infection, occur in less than 1% of cases.

Premature labor occurs in up to 10% of cases.

Who is a Candidate for Laser Photocoagulation?  

Pregnancies are considered appropriate for laser photocoagulation to treat Twin to Twin Transfusion Syndrome when they have the following:

  • Single placenta with a thin dividing membrane
  • Excess fluid around the recipient twin (greater than 8-to-10 centimeters)
  • Low fluid around the donor twin (less than two centimeters)
  • Prominent bladder in the recipient and non-filling bladder in the donor

Patients with the following situations may not be suitable for laser photocoagulation in TTTS:

  • Pre-term labor with a short or open cervix
  • Prior septostomy procedure
  • Abnormal genetic studies
  • Ruptured membranes
  • Infection of the amniotic fluid

Follow-up Care for TTTS Treatment

After the surgery, you can return to the care of your referring provider for the remainder of your pregnancy and delivery. 

Both you and your provider can always contact us if there are any questions or concerns.

Referrals for Laser Photocoagulation

If you are interested in a referral for laser photocoagulation, either you or your provider can contact our program coordinator:

Melissa Dorn, RN, MN
Fetal Therapy Coordinator  
1.866.FETSURG (toll free)