Selective fetoscopic laser photocoagulation (SFLP) may be offered when babies with twin-twin transfusion syndrome (TTTS) are very sick.

What is SFLP?

SFLP is a laser surgery to separate the abnormal blood vessel connections between the babies. During the procedure, a small cut is made on your belly. A small metal tube (trocar) is passed into your uterus through the cut. The surgeon passes a medical telescope (fetoscope) through the metal tube. This allows the surgeon to see all the abnormal blood connections on the surface of the placenta. These are the blood vessels the twins share. Then, a laser is passed through the metal tube and is applied to the abnormal connections to seal them shut. The laser disconnects them permanently. Finally, the surgeon drains the extra amniotic fluid from the uterus. Surgery is complete.

What Will I Feel During Surgery?

You will get medicine for pain (anesthesia). The location of your placenta tells your doctor what medicine you might get. For a posterior placenta (on the back wall of the uterus), you will usually get medicine through an IV and injected into the skin on the belly. For an anterior placenta (on the front wall of the uterus), you will usually get medicine through an IV and injected into the skin on the belly. You may get an epidural, if needed.

What Can I Expect After Surgery?

You will stay in the hospital for one night. If you do not live in Cincinnati, we may ask you to stay in town for five days after surgery. An ultrasound and fetal echocardiogram are repeated five days after surgery to check the condition of the babies. After testing, we will talk with your medical team (maternal fetal medicine and obstetrician) back home to make sure that careful follow up is set up.

What Does This Mean for My Pregnancy?

We may ask you to rest during your pregnancy. Your doctor will talk with you about what you can and cannot do. You will have frequent visits to your doctor at home. TTTS can put you at risk for delivering before your due date (prematurely). You should plan to deliver in a hospital with a special unit that takes care of premature babies right after birth (Level III Neonatal Intensive Care Unit).

What Does This Mean for My Babies After Birth?

Most babies treated for TTTS can live normal, healthy lives. Your babies, like any other baby, may have more serious problems if they are born before their due date. There has been research that shows some TTTS survivors can have developmental challenges. Your doctor will discuss any concerns with you as your child grows. If local specialists are not available, specialists at Cincinnati Children’s can help by providing long-term expert care for your child.