Laser Surgery: What’s the difference between Solomon and Selective Laser Ablation?
Laser Surgery has been an established treatment for twin-to-twin transfusion syndrome (TTTS) for a long time and has gone through many changes and variations over the years. At the moment, 2 types of laser surgery are considered standard treatment for TTTS: Selective Laser Ablation and Solomon Technique. This article will attempt to break down how they differ from each other. Solomon Laser is used for treating TAPS, or Twin Anemia Polycythemia Sequence.
In this video, our senior research advisor, Dr. Femke Slaghekke explains laser surgery.
What Does Laser Surgery Do?
Laser surgery stops the connections in the placentas between monochorionic twins. These connections are related to both TTTS and TAPS. Both diseases are about blood transfer between twins, with TTTS being caused by large connections and TAPS being caused by tiny connections. The idea of laser surgery is to cut off these connections and stop blood transfer between the babies.
We are grateful to Gautier Scientific Illustration and the LUMC Fetal therapy team for their generous donation of images for this article. Images may not be used or replicated without their express consent.
History of Laser Surgery
Let’s look at a brief history of laser. There are many articles out there that go into depth about laser therapy and its origins. (We will give some links throughout the page for you)
In 1984, Dr. DeLia, and a placental pathologist named Dr. Bernirschke developed a technique using lasers to stop the connections between twins. They actually used monkey and sheep placentas to practice. Then, on October 3rd, 1988, the first laser surgery was performed on a TTTS patient.
Over the years, the technique was refined further, with Selective Laser Ablation now being the most widely used treatment for TTTS. In the early 2000s, a newer method was developed called the Solomon technique. As you can see, science is continually evolving, with new types of lasers and techniques continually being refined. The objective is to improve survival rates and also be less invasive.
With Selective Laser, only the visible connections between the donor and the recipient are sealed off. The survival rate is around 74%. The idea is to target the donor and the recipient’s connections to stop the babies’ shared blood flow.
One of the biggest problems with this is that sometimes these connections are not sealed off entirely, or those tiny connections are missed. This can result in TTTS reoccurring, or post laser TAPS. This can happen in up to 16% of post-laser cases.
The Solomon Laser Technique is a recent development, that draws a line across the vascular equator of the placenta, right to the edges. It minimizes the risk of post-laser TAPS and TTTS reoccuring, because all the connections are sealed completely.
At this stage, the Solomon technique is being tested in The TAPS Trial against conventional treatments like transfusions and expectant management.
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Page updated 29/03/2021. Updated links, corrected information and changed styling.
Page updated 29/07/2021. Formatting and checked links.