Objective   To investigate the effect of fetoscopic photocoagulation of communicating placental vessels in twin-twin transfusion syndrome (TTTS) (selective or non-selective) on the perinatal outcomes.    Methods   Six cases of TTTS admitted in our department from Dec. 2006 to Jun. 2008 underwent fetoscopic photocoagulation of communicating vessels. Under direct real-time sonographic guidance

a 3-mm-diameter fetoscope was percutaneously inserted through the maternal abdominal wall into the amniotic cavity of the recipient twin. A combination of ultrasonographic and fetoscopic vision was used to identify the crossing vessels which were systematically coagulated using Nd:YAG laser fiber or bipolar electrocoagulation.    Results   All the 6 mothers tolerated the procedure without major complications. Two fetal survival rate was 33.33%.    Conclusion   Fetoscopic photocoagulation of communicating placental vessels in TTTS can effectively improve perinatal outcomes.