Author:

Keywords:

Animals, Aorta, Abdominal, Carotid Arteries, Endoscopy, Femoral Artery, Immersion, Laser Coagulation, Male, Models, Biological, Placenta, Rats, Rats, Wistar, Umbilical Cord, Vascular Surgical Procedures, Venae Cavae, Science & Technology, Life Sciences & Biomedicine, Obstetrics & Gynecology, coagulation, endoscopy, fetus, Nd:YAG laser, placenta, TWIN TRANSFUSION SYNDROME, ALUMINUM-GARNET LASER, PLACENTAL VASCULATURE, FETOSCOPY, SURGERY, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, 3213 Paediatrics, 3215 Reproductive medicine

Abstract:

Endoscopic coagulation of placental and umbilical cord vessels has been suggested as a treatment for selected cases of twin-twin transfusion syndrome and of acardiac twin. The feasibility, safety and hemostatic effect of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser in an underwater environment were experimentally studied in an in vivo model, mimicking the in utero situation and fetoplacental vessels. In 10 male Wistar rats, immersed in normal saline at 38 degrees C, femoral vessels, carotid artery, abdominal aorta and vena cava were coagulated under endoscopic control. A 100-Watt Nd:YAG laser was used in continuous mode with a 600-micron fiber. Outcome measurements were vascular diameter, total energy (joules) used to obtain visual coagulation and subsequent vascular obliteration. Overall failure rate was 32% and perforation of the vessel occurred in 7.7% of cases.