Solomon study

As shown in a recent randomized trial, the best available treatment for twin-to-twin transfusion syndrome (TTTS) to date is fetoscopic laser surgery. The aim of fetoscopic laser treatment is to interrupt the inter-twin circulation through coagulation of the vascular anastomoses on the placental surface.
Several studies have shown that laser treatment for TTTS is not always effective and failure can lead to severe complications. Up to 33% of placentas treated with laser may still have residual anastomoses. These residual anastomoses can lead to several hematologic complications, including the twin anemia-polycythemia sequence (TAPS).
A possible solution to the problem would be to adopt an alternative laser surgery technique, in which not only the anastomoses but the entire vascular equator is coagulated. The main goal of this technique is to reduce the incidence of small, residual anastomoses.
The aim of this multicenter randomized controlled trial is to compare the new laser-technique in which both placenta shares are separated by coagulation of the entire vascular equator (hence the term "Solomon") to the currently most often used selective laser technique where only the visible vascular anastomoses are coagulated.

To determine whether the ‘Solomon laser-technique’, in which the entire vascular equator is coagulated, reduces the prevalence of TAPS or recurrence of TTTS when compared to the ‘selective laser-technique’, in which only the identifiable vascular anastomoses are coagulated.

Follow-up of TTTS survivors will be 2 year.

‘Solomon technique’: after identification and coagulation of each individual anastomosis, the complete vascular equator is coagulated from one placental margin to the other. Compared to the ‘Selective technique’: The vascular anastomoses are first identified and subsequently coagulated one by one.