Skip to main content Accessibility help
×
Home

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

  • Andrew G. Edwards (a1) (a2), Mark Teoh (a1), Ryan J Hodges (a1) (a2), Ricardo Palma-Dias (a3) (a4), Stephen A. Cole (a3), Alison M. Fung (a5) and Susan P. Walker (a4) (a5)...

Abstract

The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of ‘competence based’ assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?
      Available formats
      ×

Copyright

Corresponding author

address for correspondence: Dr Andrew Edwards, Fetal Diagnostic Unit, Monash Medical Centre, Level 5, 246 Clayton Road, Clayton VIC 3168, Australia. Email: andrew.edwards@monashhealth.org

References

Hide All
Adzick, N., Thom, E., Spong, C., Brock, J. W., Burrows, P. K., Johnson, M. P., . . . Farmer, D. L. (2011). A randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine, 364, 9931004.
Akkermans, J., Peeters, S. H. P., Middeldorp, J. M., Klumper, F. J., Lopriore, E., Ryan, G., & Oepkes, D. (2015). A worldwide survey of laser surgery for twin-twin transfusion syndrome. Ultrasound in Obstetrics & Gynecology, 45, 168174.
Atug, F., Castle, E. P., Srivastav, S. K., Burgess, S. V, Thomas, R., & Davis, R. (2006). Positive surgical margins in robotic-assisted radical prostatectomy: Impact of learning curve on oncologic outcomes. European Urology, 49, 866871.
Australian Bureau of Statistics. (2015). Population clock. Retrieved November 10, 2015, from http://www.abs.gov.au/ausstats/abs@.nsf/94713ad445ff1425ca25682000192af2/1647509ef7e25faaca2568a900154b63?OpenDocument.
Australian Government Geoscience Australia. (2015). Area of Australia — States and territories. Retrieved October 29, 2015, from http://www.ga.gov.au/scientific-topics/national-location-information/dimensions/area-of-australia-states-and-territories.
Breslin, T. M., Caughran, J., Pettinga, J., Wesen, C., Mehringer, A., Yin, H., . . . Silver, S. M. (2011). Improving breast cancer care through a regional quality collaborative. Surgery, 150, 635642.
Carraccio, C., Englander, R., Van Melle, E., Ten Cate, O., Lockyer, J., Chan, M.-K., . . . Snell, L. S. (2015). Advancing competency-based medical education. Academic Medicine, Advance online publication.
Charles Sturt University. (2015). Factors affecting performance. NSW HSC Online — PDHPE. Retrieved April 27, 2015, from http://hsc.csu.edu.au/pdhpe/core2/focus2/focus4/4017/2-4-2/fac2_4_2.htm.
Cincotta, R. B., Gray, P. H., Gardener, G., Soong, B., & Chan, F. Y. (2009). Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin-twin transfusion syndrome. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 49, 2227.
Cohen, A. R., Couto, J., Cummings, J. J., Johnson, A., Joseph, G., Kaufman, B. A., . . . Wax, J. R. (2014). Position statement on fetal myelomeningocele repair. American Journal of Obstetrics and Gynecology, 210, 107111.
Cosgrove, J. F., Gaughan, M., Snowden, C. P., & Lees, T. (2008). Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates. Anaesthesia, 63, 599603.
Dawe, S. R., Windsor, J. A., Broeders, J. A. J. L., Cregan, P. C., Hewett, P. J., & Maddern, G. J. (2014). A systematic review of surgical skills transfer after simulation-based training. Annals of Surgery, 259, 236248.
De Lia, J. E., Kuhlmann, R. S., & Lopez, K. P. (1999). Treating previable twin-twin transfusion syndrome with fetoscopic laser surgery: Outcomes following the learning curve. Journal of Perinatal Medicine, 27, 6167.
Deprest, J. A., Flake, A. W., Gratacos, E., Ville, Y., Hecher, K., Nicolaides, K., . . . Harrison, M. R. (2010). The making of fetal surgery. Prenatal Diagnosis, 30, 653667.
Flikweert, E. R., Izaks, G. J., Knobben, B. A. S., Stevens, M., & Wendt, K. (2014). The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: Design and results of a clinical trial. BMC Musculoskeletal Disorders, 15, 188.
Foy, R., Hempel, S., Rubenstein, L., Suttorp, M., Seelig, M., Shanman, R., & Shekelle, P. G. (2010). Meta-analysis: Effect of interactive communication between collaborating primary care physicians and specialists. Annals of Internal Medicine, 152, 247258.
Gardner, D. B. (2005). Ten lessons in collaboration. Online Journal of Issues in Nursing, 10, 115.
Hawkins, R. E., Welcher, C. M., Holmboe, E. S., Kirk, L. M., Norcini, J. J., Simons, K. B., & Skochelak, S. E. (2015). Implementation of competency-based medical education: Are we addressing the concerns and challenges?. Medical Education, 49, 10861102.
Hecher, K., Diehl, W., Zikulnig, L., Vetter, M., & Hackelöer, B. J. (2000). Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. European Journal of Obstetrics Gynecology and Reproductive Biology, 92, 135139.
Huber, A., Diehl, W., Bregenzer, T., Hackelöer, B.-J., & Hecher, K. (2006). Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstetrics and Gynecology, 108, 333337.
Hui, L., Tabor, A., Walker, S. P., & Kilby, M. D. (2016). How to safeguard competency and training in invasive prenatal diagnosis: ‘The elephant in the room’. Ultrasound in Obstetrics and Gynecology, 47, 813.
Johnson, M. P. (2010). The North American Fetal Therapy Network (NAFTNet): A new approach to collaborative research in fetal diagnosis and therapy. Seminars in Fetal & Neonatal Medicine, 15, 5257.
King, N., Kunac, A., & Merchant, A. M. (2016). A review of endoscopic simulation: Current evidence on simulators and curricula. Journal of Surgical Education, 73, 1223.
Klaritsch, P., Albert, K., Van Mieghem, T., Gucciardo, L., Done’, E., Bynens, B., & Deprest, J. (2009). Instrumental requirements for minimal invasive fetal surgery. BJOG, 116, 188197.
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1986). An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 104, 410418.
Larsen, C. R., Oestergaard, J., Ottesen, B. S., & Soerensen, J. L. (2012). The efficacy of virtual reality simulation training in laparoscopy: A systematic review of randomized trials. Acta Obstetricia et Gynecologica Scandinavica, 91, 10151028.
Le Morvan, P., & Stock, B. (2005). Medical learning curves and the Kantian ideal. Journal of Medical Ethics, 31, 513–8.
Lemmens, V. E. P. P., Bosscha, K., van der Schelling, G., Brenninkmeijer, S., Coebergh, J. W. W., & de Hingh, I. H. J. T. (2011). Improving outcome for patients with pancreatic cancer through centralization. The British Journal of Surgery, 98, 14551462.
Lindenburg, I. T. M., Wolterbeek, R., Oepkes, D., Klumper, F. J. C. M., Vandenbussche, F. P. H. A., & Van Kamp, I. L. (2011). Quality control for intravascular intrauterine transfusion using cumulative sum (CUSUM) analysis for the monitoring of individual performance. Fetal Diagnosis and Therapy, 29, 307314.
Mehta, R. L., Kellum, J. A., Shah, S. V, & Al., E. (2007). Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Critical Care, 11, R31.
Meriki, N., Smoleniec, J., Challis, D., & Welsh, A. (2010). Immediate outcome of twin-twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW fetal therapy centre. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 50, 112119.
Middeldorp, J., Sueters, M., Lopriore, E., Klumper, F., Oepkes, D., Devlieger, R., . . . Vandenbussche, F. (2006). Fetoscopic laser surgery in 100 pregnancies with severe twin-to-twin transfusion syndrome in the Netherlands. Fetal Diagnosis and Therapy, 22, 190194.
Mitchell, L. S., Atkinson, L., Hagan-Aylor, C., Binner, B. H., Gannon, E., Weiss, P. M., & Kenny, E. (2013). Medicolegal considerations in breast health: The benefits of collaboration between OB/GYNs and radiologists. Obstetrics and Gynecology Clinics of North America, 40, 583597.
Morris, R. K., Selman, T. J., Harbidge, A., Martin, W. I., & Kilby, M. D. (2010). Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: Factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG, 117, 13501357.
Papanna, R., Biau, D. J., Mann, L. K., Johnson, A., & Moise, K. J. (2011). Use of the learning curve cumulative summation test for quantitative and individualized assessment of competency of a surgical procedure in obstetrics and gynecology: Fetoscopic laser ablation as a model. American Journal of Obstetrics and Gynecology, 204, 218.e1218.e9.
Peeters, S. H., Akkermans, J., Bustraan, J., Middeldorp, J. M., Lopriore, E., Devlieger, R., Lewi, L., Deprest, J., &Oepkes, D. (2015a). Operator competence in fetoscopic laser surgery for twin-twin transfusion syndrome: validation of a procedure-specific evaluation tool. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. Ultrasound Obstet Gynecol. 2016 Mar;47 (3):350–5.
Peeters, S. H. P., Akkermans, J., Slaghekke, F., Bustraan, J., Lopriore, E., Haak, M. C., . . . Oepkes, D. (2015b). Simulator training in fetoscopic laser surgery for TTTS: A pilot randomized controlled trial. Ultrasound in Obstetrics & Gynecology, 46, 319326.
Peeters, S. H. P., Akkermans, J., Westra, M., Lopriore, E., Middeldorp, J. M., Klumper, F. J., . . . Oepkes, D. (2015c). Identification of essential steps in laser procedure for twin-twin transfusion syndrome using the Delphi methodology: SILICONE study. Ultrasound in Obstetrics & Gynecology, 45, 439446.
Peeters, S. H. P., Van Zwet, E. W., Oepkes, D., Lopriore, E., Klumper, F. J., & Middeldorp, J. M. (2014). Learning curve for fetoscopic laser surgery using cumulative sum analysis. Acta Obstetricia et Gynecologica Scandinavica, 93, 705711.
Ramsay, C. R., Grant, A. M., Wallace, S. A., Garthwaite, P. H., Monk, A. F., & Russell, I. T. (2000). Assessment of the learning curve in health technologies: A systematic review. International Journal of Technology Assessment in Health Care, 16, 10951108.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). (2014). Management of monochorionic twin pregnancy (C-Obs 42). Retrieved January 10, 2016, from https://www.ranzcog.edu.au/college-statements-guidelines.html.
Royal College of Obstetricians and Gynaecologists (RCOG). (2008). Greentop Guideline no. 51: Management of MC twin pregnancy. Retrieved January 10, 2016, from https://www.rcog.org.uk/globalassets/documents/guidelines/t51managementmonochorionictwinpregnancy2008a.pdf.
Samra, J. S., Bachmann, R. A., Choi, J., Gill, A., Neale, M., Puttaswamy, V., . . . Hugh, T. J. (2011). One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: Role of the multidisciplinary approach. Hepatobiliary & Pancreatic Diseases International, 10, 415421.
Schmitt, M. H. (2001). Collaboration improves the quality of care: Methodological challenges and evidence from US health care research. Journal of Interprofessional Care, 15, 4766.
Senat, M.-V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., & Ville, Y. (2004). Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. The New England Journal of Medicine, 351, 136–44.
Shalhoub, J., Vesey, A. T., & Fitzgerald, J. E. F. (2014). What evidence is there for the use of workplace-based assessment in surgical training?. Journal of Surgical Education, 71, 906915.
Soubbotina, T. P. (2000). Beyond economic growth. Washington, DC: The World Bank. Retrieved November 11, 2015, from http://www.worldbank.org/depweb/beyond/beyondco/beg_03.pdf
Sroka, G., Feldman, L. S., Vassiliou, M. C., Kaneva, P. A., Fayez, R., & Fried, G. M. (2010). Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room — A randomized controlled trial. American Journal of Surgery, 199, 115120.
Stelzer, P., Weinrauch, S., & Tranbaugh, R. (1998). Ten years of experience with the modified ross procedure. Journal of Thoracic and Cardiovascular Surgery, 115, 10911100.
Stepaniak, P. S., Vrijland, W. W., de Quelerij, M., de Vries, G., & Heij, C. (2010). Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time. Archives of Surgery, 145, 11651170.
Tang, C. J., Chan, S. W., Zhou, W. T., & Liaw, S. Y. (2013). Collaboration between hospital physicians and nurses: An integrated literature review. International Nursing Review, 60, 291302.
Urbaniak, S. J., & Greiss, M. A. (2000). RhD haemolytic disease of the fetus and the newborn. Blood Reviews, 14, 4461.
World Bank. (2013). Birth rate, crude (per 1,000 people). Retrieved October 29, 2015, from http://data.worldbank.org/indicator/SP.DYN.CBRT.IN/countries.
World Bank. (2014). Population density (people per sq. km of land area). Retrieved October 29, 2015, from http://data.worldbank.org/indicator/EN.POP.DNST.
World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice (WHO Technical Document). Geneva: Author.
Wright, T. (1936). Factors affecting the costs of airplanes. Journal of Aeronautical Sciences, 3, 122128.
Yamamoto, M., Murr, L. El., Robyr, R., Leleu, F., Takahashi, Y., & Ville, Y. (2005). Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. American Journal of Obstetrics and Gynecology, 193, 11101116.
Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interprofessional collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes. Cocharane Database of Systematic Reviews, 2009, (3). doi: 10.1002/14651858.CD000072.pub2.

Keywords

Related content

Powered by UNSILO

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

  • Andrew G. Edwards (a1) (a2), Mark Teoh (a1), Ryan J Hodges (a1) (a2), Ricardo Palma-Dias (a3) (a4), Stephen A. Cole (a3), Alison M. Fung (a5) and Susan P. Walker (a4) (a5)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.