Conjoined Twins Separation Surgery
Conjoined twins separation surgery is a surgical procedure that helps to separate conjoined twins. This is a common surgery and can be performed with minimal pain and complications. In most cases, postoperative care and invasive monitoring is required after the operation.
Age at operation influences success
Surgical separation of conjoined twins is a complex procedure that requires multidisciplinary cooperation during the perioperative period. A team must include nurses from different specialties. The team must also include psychologists, nutritionists, pharmacists, and social workers.
Surgical separation of conjoined twins presents unique ethical challenges. There are a variety of therapeutic options, including conservative nonsurgical management, emergency surgery, and elective surgery. It is important to choose the best approach for the individual case.
UC Davis Children’s Surgery Center is an institution specially built for complex surgeries. A team of more than 30 specialists worked together to separate eight-day-old conjoined twin sisters.
Abigail and Micela Bachinskiy were born connected at the head. They are now in the Pediatric Intensive Care Unit at UC Davis Health. Their doctors have cared for them since before their birth.
Prior to their surgery, the team conducted an extensive preoperative simulation. All members of the team participated in the simulation. Two color codes were used to mark the patients and team members.
Preserving normothermia during surgery
The anesthesia care team must ensure proper intra-anesthesia monitoring in conjoined twins. This is crucial to successful surgery. Moreover, it is important to maintain normothermia. For this purpose, the operating room should be well-ventilated, heated and equipped with individual coded equipment.
Separation of conjoined twins can be life-threatening. Fortunately, advances in surgical techniques and imaging have increased survival rates. However, these procedures require a multidisciplinary team. In the case of Conner and Carter, nearly 200 health professionals helped them to survive.
They underwent 12-hour separation surgery in May 2015 after being born as conjoined twins. Their livers were partially separated and their abdominal wall defect was repaired. After the surgery, both babies were placed in a neonatal intensive care unit (NICU) and received postoperative care.
Anesthesia care is conducted by two independent anaesthetic teams. Each team anesthetizes the twins sequentially. Anaesthesia is maintained by a combination of inhalational anaesthesia and fractionated doses of opioids.
The anesthetic management of conjoined twins is highly complex. It requires multidisciplinary teams of specialists, including pediatric surgeons, urologists, anesthesiologists, and orthopaedic surgeons.
Postoperative care and invasive monitoring on ICU are mandatory in most cases
Separation of conjoined twins is a complicated and risky operation. It requires a large team of physicians, nurses, and other specialists. The success of this surgical procedure depends on the preoperative evaluation and planning.
Anesthesia is crucial in this surgery, but is not the only aspect. For instance, the positioning of the twins may impact anaesthesia. Other considerations include the anatomy of the organs involved and the nature of the conjunction.
The occurrence of a sudden heart failure at the time of separation can be a serious complication. Sudden loss of blood from the circulation can cause heart failure. To minimize this, a stable haemodynamic state is important.
During the perioperative period, the separation team should be well coordinated. This includes social workers, nutritionists, and other professionals. A discharge meeting should be organized after the surgery to include the parents and the patient’s rehabilitation specialist.
The anesthesia plan should include the staffing location and the equipment used for the procedure. Also, a checklist should be used to minimize errors.
Rehabilitation for conjoined twins during the COVID-19 pandemic
Conjoined twins present special challenges for therapists. They have unique medical needs, differences in body tissues, and shared experiences. Because of these differences, the team needs to work together to find solutions.
The complexity of separating conjoined twins increased during the COVID-19 pandemic. Consequently, a team of specialists was formed to manage the situation. Among the prominent members were neonatologists, pediatricians, social workers, a developmental specialist, and a physical rehabilitation specialist.
The goal of the physical and occupational therapy team is to promote optimal stimulation and development for the twins. In addition, therapists must consider the unique presentation of the twins and their similarities.
To provide an effective therapy environment, regular therapy times were established. Music was played to help normalize the hospital setting. Social distancing protocols were also implemented.
During the perioperative period, the surgical and medical teams at GOSH complied with strict infection control practices. Fibrinogen concentrate was given to each child as a prophylactic treatment. This reduced bleeding during osteotomy.
