Fetoscopic Laser Surgery at TMC Gives a Fighting Chance to Twins with TTTS

At 24 weeks pregnant, a mother faced a reality no parent should have to hear: her twins were in danger.

Diagnosed with Twin-to-Twin Transfusion Syndrome (TTTS), a rare but serious condition affecting identical twins who share a placenta, her pregnancy had suddenly become high-risk. One baby was receiving too little blood and nutrients, while the other was overwhelmed with too much. Without intervention, both lives were at risk.

For many families, this diagnosis leaves little room for hope.

But for this mother, there was a choice.

Referred to The Medical City (TMC), she arrived at a critical stage. One of her babies was already showing signs of strain, and the condition was progressing quickly. Time was no longer on their side.

“She knew the risks,” shared Dr. Ma. Cresilda Paz Salamilao-Sabularce, TMC’s lead fetal surgeon. “But she chose to do something rather than wait and face further complications.”

That decision changed everything.

A Mother’s Courage 

The Medical City team supports a mother undergoing fetoscopic laser surgery for a high-risk pregnancy.

While the condition directly affects the babies, the burden of treatment falls on the mother.

The procedure, fetoscopic laser photocoagulation surgery, involves inserting a small camera into the womb to stop the abnormal blood vessel connections between the twins. It is done through the mother’s body, requiring anesthesia and careful monitoring.

“You’re perfectly well as a mother, but you choose to undergo a procedure because your babies need it,” Dr. Sabularce explained. “That takes courage. You place yourself on the line to give them a chance.”

TTTS can progress quickly. Just weeks after a normal scan, the imbalance between the twins became severe.

One baby had very little amniotic fluid. The other had too much, putting strain on its heart. At this stage, the condition could lead to life-threatening complications within a short period of time.

The goal of the procedure was simple: stop the imbalance and give each baby a fair chance to survive.

By sealing the abnormal connections in the placenta, the twins’ blood circulation could be separated, allowing each baby to grow independently.

A First for The Medical City

The multidisciplinary team from TMC’s Institute for Women’s Health, in collaboration with Quirino Memorial Medical Center, that performed TMC’s first fetoscopic laser photocoagulation surgery.

This case marked the first fetoscopic photocoagulation laser surgery performed at TMC, a significant step forward in expanding access to advanced fetal care in the country.

For years, this type of intervention was not readily accessible locally. Families often had limited options, either manage the condition or seek treatment abroad.

“This capability means Filipino patients no longer have to leave the country or simply wait and hope,” Dr. Sabularce said. “We can offer a treatment that directly addresses the problem.”

For Dr. Zarinah Gonzaga, Institute Director of TMC’s Institute for Women’s Health, this milestone reflects years of preparation and commitment.

“Setting up our Fetal Care Program was a long and challenging journey. We had to navigate the logistical hurdles of securing highly specialized equipment while building a team capable of performing complex in-utero surgery,” she shared. “While it remains a work in progress, this launch is a massive leap forward for our Fetal Care Program.”

Care That Reaches Those Who Need It Most

Expertise and coordination come together as The Medical City team delivers advanced fetal care through fetoscopic laser photocoagulation surgery.

The procedure was completed successfully, and the abnormal blood flow between the twins was addressed.

Today, the focus remains on close monitoring and supporting the pregnancy for as long as possible, while giving the mother the care she needs every step of the way.

This life-saving intervention was made possible through The Medical City’s broader commitment to accessible healthcare. As part of its commitment to social responsibility, the procedure was extended to the mother, an indigent patient, ensuring that financial limitations did not stand in the way of critical care.

By expanding access to this procedure, The Medical City helps ensure that mothers facing high-risk pregnancies are given a real chance at better outcomes, and that where a family comes from does not determine the care they can receive.

The procedure was carried out by a highly trained multidisciplinary team from TMC’s Institute for Women’s Health. Leading the surgery was Dr. Salamilao-Sabularce, TMC’s lead fetal surgeon, who has undergone advanced training in fetal therapy and minimally invasive surgery in Spain, Colombia, and Germany.

She was joined by Dr. Joanna Pauline Chua-Ursua as first assist, with Dr. Ma. Rosario Castillo-Cheng, Section Head of Maternal Fetal Medicine, and Dr. Joseph Carl M. Macalintal, Assistant Training Officer for Maternal Fetal Medicine, serving as second assists.

Supporting the procedure were specialists and clinical staff under the direction of Dr. Zarinah Gonzaga, Director of the Institute for Women’s Health, with operational support from Business Manager Dr. Joana Lingao, alongside the nursing team led by Delivery Suite Supervisor Yolly Villegas and Women’s Health Care Center Head Nurse Loraine Rivera.

About The Medical City

The Medical City is the Philippines’ largest integrated healthcare network operating under a single brand. It is composed of one flagship complex in Ortigas, five provincial hospitals in Clark, South Luzon (Laguna), Iloilo, and Pangasinan, the only private hospital in Guam, USA, and over 70 clinics nationwide, serving patients across the country.

With multiple Joint Commission International (JCI) accreditations, global benchmark certifications, and continued investment in innovation, The Medical City is building a healthcare system not just for today, but for the future of Filipino care.