Direct visual control on cord coagulation using a fetoscopy-guided bipolar forceps. Description of a new technique

Objective We describe a new technique to achieve permanent umbilical cord occlusion. Methods A 3 mm in diameter bipolar diathermy forceps was built to house a 1.2 mm fetoscope, emerging between the blades of the forceps. The device can be inserted percutaneously through a 10 Fr Trocar into the amniotic cavity under local analgesia and ultrasound guidance. A monochorionic (MC) twin pregnancy with a twin reversed arterial perfusion sequence at 18 weeks of gestation underwent cord occlusion of the acardiac twin using this new device in 2004. Results The instrument allowed cord coagulation under direct visual control. The pregnancy continued until 33 weeks of gestation when a male infant of 1980 g was delivered by cesarean section following preterm labor. Conclusion This new instrument might allow easier access to the cord and reduce operation time by direct visualization of the targe and, therefore, improve the outcome after the procedure. Copyright (C) 2009 John Wiley & Sons, Ltd.