Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases.
Lisanne S A Tollenaar, Enrico Lopriore, Stefano Faiola...
https://pubmed.ncbi.nlm.nih.gov/32517071/Actively Recruiting
Led by Boston Children's Hospital · Updated on 2024-09-25
50
Participants Needed
1
Research Sites
21 weeks
Total Duration
Researchers are studying the use of two new surgical devices, the Karl Storz Curved and Straight Fetoscopes, to assist in minimally invasive in-utero surgeries. These devices help surgeons see inside the uterus during procedures to treat fetal conditions like twin-twin transfusion syndrome and other complex anomalies. The study aims to assess surgical outcomes, complications, and gestational age in patients treated with these scopes, helping to understand their potential benefits in fetal surgery. The curved fetoscope is designed for patients with an anterior placenta, while the straight fetoscope is used for those with a posterior placenta. Both scopes assist in fetoscopic laser photocoagulation, a procedure that seals abnormal blood vessels in the placenta using laser energy. This research is a non-randomized, single arm study where eligible patients undergo intrauterine procedures with either the curved or straight scopes based on placenta position. The study will collect data on the success of the procedures and related complications for descriptive analysis. Participants will be monitored through the procedure and follow-up until birth and shortly after. The study will evaluate outcomes such as the rate of completed fetoscopic procedures, fetal survival at birth, and various maternal and fetal complications. Researchers will also track gestational age at delivery, procedure length, and short-term neonatal health. The total study duration extends over several years to capture both immediate and longer-term results of using these devices in fetal surgery.
CONDITIONS
A Prospective Study on the Role of Karl Storz Curved and Straight Fetoscopes (11508AAK and 11506AAK) for Fetoscopic Intrauterine Procedures
B
Brittany Gudanowski
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Boston Children's Hospital
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Karl Storz Curved or Straight Fetoscope (Trial Device) | Standard Straight Fetoscope (Current Care) |
|---|---|---|
| What it is | A set of investigational Karl Storz fetoscopes (curved model 11508AAK and straight model 11506AAK) designed for minimally invasive intrauterine visualization and intervention during fetoscopic procedures for complex fetal conditions requiring surgery. | Conventional fetoscopic laser surgery using standard straight fetoscopes, the established tool for fetoscopic interventions such as vessel photocoagulation in twin-to-twin transfusion syndrome and other conditions. |
| Role in trial | This device is used during fetoscopic procedures for participants requiring intrauterine intervention, allowing targeted visualization and treatment of abnormal placental or fetal vessel conditions. | Serves as the current clinical standard for performing fetoscopic interventions, including vessel coagulation and tissue manipulation in eligible fetal surgery cases. |
| Primary use | To facilitate fetoscopic intrauterine surgery for conditions such as abnormal vessel connections, TTTS, vasa previa, and others, particularly where placental location or anatomy may constrain access. | To provide visualization and enable minimally invasive surgical treatment, most commonly laser photocoagulation for TTTS and related fetal conditions. |
| How it is given or performed | The fetoscope (curved or straight, selected based on placental location) is inserted into the uterus under anesthesia during minimally invasive fetal surgery to allow visualization and treatment of placental or vascular abnormalities. | The standard straight fetoscope is introduced into the amniotic cavity, typically via a transabdominal route under anesthesia, to perform visualization, laser treatment of communicating vessels, or other necessary interventions. |
| Evidence status | Currently being studied; no published results yet available for the trial evaluating these specific device models and surgical outcomes. | Multiple randomized clinical trials and guidelines support the safety and efficacy of standard fetoscopic laser photocoagulation (using straight fetoscopes), especially for TTTS, with improved perinatal survival and reduced neurological morbidity versus older approaches. |
| Important limitations | Limited by early clinical experience, absence of outcome data for current device models, and single-group non-randomized design. Device-specific risks and comparative effectiveness versus conventional techniques remain to be determined. | Technical difficulties may occur with placental position (especially anterior placenta), limited visualization, instrument maneuverability, and entry technique risks such as preterm rupture of membranes. Experienced operator skill remains important. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
You may qualify if you...
You will not qualify if you...
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Procedure day plus immediate recovery
Participants undergo in-utero surgery using either a Karl Storz Curved or Straight Fetoscope to assist with visualization during the procedure.
1 surgical procedure visit (in-person)
Duration - Up to birth and 30 days post-birth
Participants are monitored for short and long-term outcomes including fetal survival, complications, and gestational age at delivery.
Multiple follow-up visits until delivery and neonatal period
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
NA
Model
SINGLE_GROUP
Primary Purpose
TREATMENT
Number of Arms
1
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Lead Sponsor