SURGICAL UPDATE ON CONJOINED TWINS SEPARATIONOn Monday, 21 January 2002, at 0820 hours, the twins were taken to the Operating Room where the surgical team started anaesthetizing them, one at a time, starting with Twin A (Najlaa) and followed by Twin B (Naseebah). After they were put to sleep and connected to the anaesthesia machines, endotracheal tubes were placed and the Anaesthesia team proceeded to place the monitoring devices, central intravenous lines and arterial lines for both twins.
The second phase of the operation started after 2½ hours. Both twins were cleaned with antiseptic solutions to prepare the surgical field for the operation and sterile coverings were applied on the babies. The Pediatric Surgical team started to open between the two twins after carefully studying the area of separation. The division was started at the chest and then proceeded to the abdomen where the umbilicus was kept for Twin A (Najlaa). Once the abdomen was opened, the team from Pediatric Cardiac Surgery and Plastic Surgery joined; subsequently, the chest was also opened between the two babies. The opening of the chest and abdomen showed that the twins were joined at the ribs, sternum, pericardium, and the whole surface of the liver. The Surgical team continued to open the common pericardium, where it was clear that both hearts were separate from each other.
Phase 3 of the operation then started; it mainly involved the Pediatric Surgical team. The abdominal wall was completely divided between the two twins and the shared liver was divided equally between the twins using modern technology (Cusa, Argon laser diathermy, standard uni-polar electrocautery and hemo-clips). The liver separation was successful with surprisingly minimal blood loss compared to other such major operations.
The Pediatric Surgical team continued to work on the abdominal wall separation from the back of the joined area completing the muscles, fascia and skin up to the chest from the back. Twin A had a small abnormality of her bowel, which was corrected.
Phase 4 of the operation was then started where the connection between the two chests of the twins was separated from the back, and which was carried out by dividing the diaphragm between the two babies. This then completed the final separation of the twins and the two babies were separated and placed on two separate tables.
Phase 5 of the operation was carried out by two teams, including Pediatric Surgery, Pediatric Cardiac Surgery and Plastic Surgery where each heart of the baby was covered with the divided pericardium. Twin A required an artificial patch (Gortex sheet), whereas Twin B did not require any artificial tissue. The abnormality in the chest was also corrected for cosmetic purposes and the closure was started in Twin A, Najlaa and then carried out on Twin B, Naseebah.
It was fortunate that the Surgical teams were able to successfully close both twins without any additional foreign tissue.
The operation was competed at 1715 hours with the total operating time being about 9 hours.
CONJOINED TWINS SURGICAL TEAM
Surgery Date: Monday, 21 January 2002
Time: 8:30 am
TEAM LEADER – Dr. Abdullah Al Rabeeah, Consultant, Division of Pediatric Surgery
Department of Surgery - Division of Pediatric Surgery
- Dr. James Fischer, Chairman, Department of Surgery, & Consultant
- Dr. Saud Al Jadaan – Consultant
- Dr. Stanley Crankson – Consultant
Department of Cardiac Sciences – Division of Cardiac Surgery
- Dr. Hani Najm, (A) Head
- Dr. Mohamed Adel, Assistant Consultant
Department of Surgery – Division of Plastic Surgery
- Dr. Abdullah Al Thunayan, Consultant
Department of Anaesthesia
- Dr. Mohamed El Gammal – Team Leader
- Dr. Charles Ahene – Consultant
- Dr. Abdullah Al Showmer – Resident
- Dr. Al Johara Hamza – Resident
- Mr. Salem Al Shammari – Anaesthesia Technician
- Mr. Mohamed Khamis – Anaesthesia Technician
Nursing Services – Nursing O.R.
- Cheryl Olson, RN SN1 – O.R. Supervisor
- Hilary Ashby, RN SN1 – Team Leader
- Juliette Bagasala, RN SN2
- Mervi Roos, RN SN1
- Ross Padilla, RN SN1
- Connie Chan, RN SN1
- Ruperto Depakaribo, RN SN2