Laser distance measurement using a newly developed composite-type optical fiberscope for fetoscopic laser surgery

Twin–twin transfusion syndrome (TTTS) is a condition of twins disproportionately sharing blood by the communicating vessels in the shared placenta and resulting in the significantly high fetal and perinatal mortality rate. Fetoscopic laser surgery is performed to block these communicating vessels. It is difficult, however, to perceive the distance from the tip of the fetoscope to the placental surface with only a two-dimensional fetoscopic view. When the distance is too short it causes excessive irradiation and even the risk of inadvertent damage to the placenta. On the other hand, not only target vessels but also adjacent tissues can be irradiated when it is too long.We have developed a composite-type optical fiberscope (COF) that was able to observe the target area and also to perform laser irradiation at the same time. In this paper, we studied a method to estimate the distance from the tip of the COF to the target area. We combined the COF with a laser blood-flow meter. Using laser light from the meter, we measured the total amount of light received (“REFLEX”) and estimated the relation between the “REFLEX” value and the laser irradiation distance. Further in vivo experiments were subsequently carried out using porcine mesenteric blood vessels.The results showed that the distance and the “REFLEX” value were inversely proportional, irrespective of the experimental environment (e.g. in air, water and amniotic fluid-like solution) and the target object. In the in vivo experiments, we quantitatively measured the distance within an accuracy of ±1 mm (approximately 10%).In conclusion, our new system was able to measure the distance in vivo enabling a surgeon to safely and effectively perform laser irradiation at a suitable distance. The system can be used not only for fetoscopic surgery but also for general endoscopic surgery.