Fetoscopic Laser Surgery for TTTS

If you are carrying twins diagnosed with twin-twin transfusion syndrome (TTTS), a type of minimally invasive fetal surgery called fetoscopic laser surgery may be recommended.

Also called selective laser photocoagulation (SLPC) surgery, this prenatal treatment option is performed before birth. The goal of TTTS laser surgery is to stop the uneven blood flow between the two babies that happens in TTTS.

For this TTTS treatment, a tiny laser fiber is used to disconnect the communicating blood vessels that lie on the surface of the placenta. This stops the sharing of blood with the goal of halting the progression of twin-twin transfusion syndrome.

Fetoscopic laser surgery is typically the preferred treatment for TTTS, depending on the gestational age when the babies are diagnosed, the location of the placenta, and the stage of TTTS.

Traditionally, fetoscopic laser ablation surgery has been used as a first-line treatment for patients with stage II-IV TTTS or in patients with Stage I TTTS with additional risk factors.

What to expect during TTTS laser surgery

If fetoscopic laser surgery is determined to be the best course of treatment for your babies, you will meet with the team to discuss the surgery and have all of your questions answered.

On the day of the procedure, you will be admitted to the Hospital early in the morning and taken to our state-of-the-art fetal surgery operating room. There, you will be put under conscious sedation. This is a combination of medicines that will help you relax and block pain. You will be able to speak and breath on your own, but most patients feel sleepy and nap. A local anesthetic will be applied to your abdomen to numb your skin.

One of our maternal-fetal medicine specialists will then insert a fetoscope, a long thin tube with a camera on the end, into your uterus. This gives us a detailed view of the blood vessel communications, or connections, that occur on the surface of the placenta.

Using sophisticated endoscopic techniques and instruments, we’re able to map out every single blood vessel and determine the specific connections that need to be closed. Using a laser fiber, we will then coagulate (seal) those communications shut. This effectively separates the single, shared placenta into two separate sections, one for each baby.

By sealing off the communicating blood vessels, the goal of laser surgery for TTTS is to halt the progression of TTTS and reduce the strain on the recipient twin’s heart. This increases both babies’ chances for survival by stabilizing the situation and giving them more time to grow in the womb.


Although fetoscopic laser photocoagulation is a minimally invasive procedure, it is still surgery. As with any surgery, patients and doctors should weigh the risks against the potential benefits.

Potential risks include preterm labor, membrane complications, and loss of one or both babies.

There is an approximately 10 to 15 percent chance of developing one of these complications. However, once stage II TTTS develops, there is over a 95 percent chance of losing the pregnancy without treatment.

Why choose us for TTTS surgery

Children's Hospital is one of a handful of hospitals worldwide that performs fetoscopic laser ablation for TTTS.

Our team has cared for a very high volume of patients diagnosed with TTTS, and has a great deal of experience performing TTTS surgery. We’ve used this experience to develop a multidisciplinary approach to care specifically designed to meet the needs of families affected by TTTS.

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