Doctors' hopes high for conjoined twins

By NICOLA BOYES


Conjoined baby twins separated in a historic operation at Waikato Hospital were recovering well last night and had movement in their legs.

But surgeons who performed the marathon 22-hour surgery on the twins say it is too early to know if the tiny babies will live a normal life.

The twins, whose sex has not been disclosed, were joined at the lower spine and pelvis.

They will face years of further surgery as they grow and develop.

Only 30 cases of pygopagus twins - those joined at the lower spine - being separated have been reported worldwide, and this is the first for New Zealand and Australia.

Orthopaedic surgeon David Clews said the babies had movement in their legs, but were difficult to examine in the intensive care unit, where their breathing and organ functions were being controlled.

Paediatric surgeon Askar Kukkady, who headed the team of surgeons, said it was too early to know how the separation of the babies would affect them later in life.

They were taken to intensive care as soon as the surgery finished at 6am on Wednesday and are expected to stay there for at least 10 days.

Mr Kukkady remembers clearly when the surgery finished. He had kept in hourly contact with the babies' parents.

"The mum came and hugged me, and it was a really, really great feeling for all concerned.

"Here were two parents dearly attached to their children not knowing if they were going to make it through the operation, and then you have two babies coming out in great nick."

Mr Clews said the babies would probably face reconstructive surgery, including skin grafting and bone reconstruction.

They appeared to be functioning normally, although they had undergone delicate neurosurgery to separate shared spinal nerves.


"To date, everything is looking very positive."

Mr Clews said seven or eight different procedures were carried out on the babies during the surgery.

The whole surgical team had become close to the babies' family, who had known the twins were conjoined since the first ultrasound scan.

"We have known for a long time that the relationship we have with this family will be long term," Mr Clews said.


Paediatric charge nurse Heather Glen also assisted in the separation of twins at Waikato Hospital in 1987.

"I thought the first was an experience of a lifetime," she said. "This is amazing.

"It's just a large privilege and wonderful, wonderful experience."

The babies were born prematurely at Waikato Hospital. No birth date has been given, but it is understood to have been around July.

The babies' parents, who do not want to be identified or have the age or sex of the babies given, are staying at the hospital.

Mr Kukkady said the parents were emotional when the diagnosis of conjoined twins was made.

"Every parent expects things to be normal with their baby, but these things happen. They decided to continue and have the babies and they were very clear as to what to expect."

The parents had the support of a large extended family.

Mr Kukkady said the family were given the option of having the surgery done in Auckland but chose to stay at Waikato Hospital in Hamilton.


A team of seven senior surgeons, nurses, an anaesthetist and radiologists worked from 8am on Tuesday until 6am on Wednesday to separate the babies.

The most delicate procedure was separating their spinal cords.

Planning for the surgery started as soon as the parents found out they were having conjoined twins.

The overall procedure had never been performed in Australia or New Zealand, but Mr Kukkady said the techniques and procedures used on the babies had each individually been done on patients before.

The surgeons had also sought advice and literature from overseas.

Two weeks before the surgery, the team had a trial run with dolls the same size as the babies, made by the hospital's orthotic department.

Mr Kukkady said the babies were anaesthetised and positioned on the operating table for the skin on their backs to be lifted, exposing the fused area.

The orthopaedic team then separated the babies' spines and exposed the spinal canal.

Neurosurgeons took over, using a microscope to separate the shared spinal nerves.

They then separated the organs which the babies shared and separated major blood vessels.

Surgeons would not detail the organs, but nurses involved included ear, nose and throat specialists.

The babies were then turned on the operating table and skin and bone were separated on their fronts.

It took 17 hours to separate them and a further five to reconstruct bone and use skin to cover the wounds.

Mr Kukkady said the operation took so long because of the organs and tissue involved.

"At this stage we're still waiting for the babies to go home so we can say we've achieved the operation successfully."

The operation was filmed on closed circuit television so other doctors could watch, and the separation will be the subject of a medical report.