Impact of laser power and firing angle on coagulation efficiency in laser treatment for twin-twin transfusion syndrome: an ex vivo placenta study

Joost Akkermans, Loes van der Donk, Suzanne H.P. Peeters, Sjoerd van Tuijl, Johanna M. Middeldorp, Enrico Lopriore, Dick Oepkes

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
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Abstract

Objective: To assess the impact of laser power and firing angle on coagulation efficiency for closing placental anastomoses in the treatment of twin-twin transfusion syndrome. Methods: We used an ex vivo blood-perfused human placenta model to compare time to complete coagulation using 30 vs. 50 W of neodymium-doped yttrium aluminum garnet laser power and using a firing angle of 90° vs. 45°. Placentas were perfused with pig blood at 5 mL/min. Differences were analyzed using independent-samples t test, Mann-Whitney U test, or χ2 test as appropriate. Results: Coagulation took less time and energy using 50 W (n = 53) compared to 30 W (n = 52), 11 vs. 22 s (p < 0.001), and 557 vs. 659 J (p = 0.007). Perpendicular coagulation (n = 53) took less time and energy compared to a 45° angle (n = 21), 11 vs. 17 s (p = 0.004), and 557 vs. 871 J (p = 0.004). Bleeding complicated 2 (3%) measurements in the 50-W group, 5 (10%) in the 30-W group, and 3 (14%) in the 45° group. Discussion: In a highly controlled model, a 50-W laser power setting was more energy efficient than 30 W in coagulating a placental vein. A more perpendicular laser firing angle resulted in more efficient coagulation. Furthermore, bleeding due to vessel wall disruption occurred more often with lower power and a more tangential approach.

Original languageEnglish
Pages (from-to)204-209
Number of pages6
JournalFetal Diagnosis and Therapy
Volume42
Issue number3
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • Laser energy
  • Laser power
  • Laser therapy
  • Placenta
  • Twin-twin transfusion syndrome
  • Laser Coagulation/instrumentation
  • Humans
  • Placenta/pathology
  • Pregnancy
  • Animals
  • Swine
  • Fetofetal Transfusion/surgery
  • Female
  • In Vitro Techniques

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