The use of laser therapy in fetal medicine: a narrative review.

Introduction: Fetal therapy has evolved into an established clinical specialty in fetal medicine, offering life-saving interventions for conditions with high intrauterine morbidity and mortality. Among various approaches, laser therapy has played a significant role in advancing fetal procedures.

Content: The most established application of laser is fetoscopic laser coagulation for twin-twin transfusion syndrome, which significantly reduces perinatal mortality and neurological complications. Other indications include twin anemia-polycythemia sequence and, as an intrafetal application, twin reversed arterial perfusion sequence. As an experimental approach, intrafetal laser therapy can be used to close the feeding blood vessel of unwanted tissue, thus preventing further tissue growth. Despite the advantages of fetal laser therapy, it presents challenges such as preterm premature rupture of membranes, preterm birth, technical difficulties, and the need for specialized expertise.

Summary: Laser therapy has become a cornerstone of fetal medicine, demonstrating significant clinical benefits. While laser therapy for TTTS is supported by high-level evidence, other applications rely on observational or experimental data.

Outlook: Future advancements, including improved imaging technologies, artificial intelligence, and robotic-assisted techniques, are expected to further enhance the precision, safety, and accessibility of fetal laser therapy. Large-scale studies through international collaborations will be essential to standardize protocols and improve outcomes.