Rapid initiation of fetal therapy services with a system of learner-centred training under proctorship: the National University Hospital (Singapore) experience
| Autor: | Pradip D. Vijayakumar, Yi Wan Tan, Dedy Sandikin, Tuangsit Wataganara, Mahesh Choolani, Lay Geok Tan, Lin Lin Su, Arundhati Gosavi, Bryan Sw Ng, May-Han Loh, Citra Nz Mattar, Arijit Biswas, Nuryanti Johana |
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| Rok vydání: | 2017 |
| Předmět: |
Radiofrequency ablation
law.invention Hospitals University Fetoscopy 03 medical and health sciences 0302 clinical medicine Nursing Pregnancy law medicine Humans 030212 general & internal medicine Selective feticide Fetal therapy Twin Pregnancy Fetal Therapies Singapore 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Fetofetal Transfusion General Medicine medicine.disease Catheter Ablation Pregnancy Twin Original Article Education Medical Continuing Female Laser Therapy Monochorionic twins Medical emergency Apprenticeship business |
| Zdroj: | Singapore Medical Journal. 58:311-320 |
| ISSN: | 0037-5675 |
| DOI: | 10.11622/smedj.2016127 |
| Popis: | Introduction Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units. Methods Five pregnancies with fetal complications were identified for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision. Results All co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise. Discussion Proctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefit other small units committed to providing these services. |
| Databáze: | OpenAIRE |
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