The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous laser therapy for fetal tumours in June 2006. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.
The guidance was considered for reassessment in June 2009 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.
This guidance has considered the following types of fetal tumours: sacrococcygeal teratomas, cervical teratomas, cystic hygromas and congenital cystic adenomatoid malformations (CCAM). These tumours are usually benign, although teratomas may also be malignant. The tumours can become very large and highly vascularised, causing stress on the fetal heart, leading to the development of heart failure. Fetal mortality is high and a poor prognosis is associated with non-immune hydrops fetalis, placentomegaly, cardiomegaly, large tumour size and high tumour growth rate.
Percutaneous laser therapy for fetal tumours involves using laser energy to destroy tumour tissues and to coagulate blood vessels within the tumour. The procedure is performed under maternal local anaesthesia and light sedation by inserting a needle into the uterine cavity through the mother's abdomen under ultrasonographic guidance. An analgesic is then injected subcutaneously or intramuscularly into the fetus before advancing the needle to the site of the fetal tumour. Colour-Doppler imaging is used to guide placement of the needle. A laser fibre is passed through the needle lumen and laser energy is then delivered in pulses causing destruction of tumour tissues and coagulation of blood vessels within the tumour.
R04.7 Percutaneous laser ablation of lesion of fetus
A code from categoryY95.- Gestational age must be assigned in a subsidiary position where this information is available.
Y53.2 Approach to organ under ultrasonic control
Code from Chapter Z to identify site of tumour