A closer look at the successful severance of conjoined twins

By Huu Khoa, Anh Thu   July 16, 2020 | 07:50 am PT
The 13-hour separation of conjoined twins in Ho Chi Minh City on Wednesday took over 93 medical experts to complete.
At 6 a.m. Wednesday, doctors and nurses at HCMC Childrens Hospital get ready for the surgery of two 13-month old conjoined twins, Truc Nhi and Dieu Nhi.

At 6 a.m. Wednesday, HCMC Children's Hospital staff lead two 13-month-old conjoined twins, Truc Nhi and Dieu Nhi, to surgery, gathering around 93 doctors, nurses and medical experts from several HCMC hospitals.

The siblings were classified Ischiopagus Tetrapus (Quadripus) conjoined twins, which means they have a symmetrical continuous longitudinal axis with their area of union not broken anteriorly. If a pair of conjoined twins is born for every 200,000 births, only 6 percent of such cases are classified as Ischiopagus Tetrapus, doctors said. The twins have a colon frame and only one anus, two bladders located on both sides of the abdominal cavity, and a circular pelvis.

To distinguish the two children and to avoid confusing personnel and surgical equipment, nurses put color papers on each of therr foreheads. Before anesthesia, two children are awake and playful on the surgical table.

To distinguish the two children and to avoid confusing personnel and surgical equipment, nurses stuck color paper to each of their foreheads.

To reassure the children, two nurses were assigned to take care of them and soothe them during pre-anesthesia.

Two nurses soothe the tiny patients pre-anesthesia.

Depending on the condition of each child, anesthesiologist calculates the amount of medication for each child. Since they have not been separated and the two of them have drug exchange, so the anesthetic team are very careful. The procedure lasts for nearly three hours.

Since the twins had yet to be separated and still experienced conjoined drug exchange, the anesthetic team had to be very careful when administering dosages, taking nearly three hours to complete the procedure.

Truong Quang Dinh, director of the HCMC Childrens Hospital (wearing stethoscope),  City Childrens Hospital (wearing a headset), the head of the operation, the main surgeon, directly hears the heart rate, measures the blood pressure for Dieu Nhi before placing a coward first knife. He listened carefully to each patients breathing.7h30, the surgical team last consulted before surgery to determine the implementation plan, the coordination phase of other groups.

Truong Quang Dinh, director of HCMC Children's Hospital (wearing stethoscope) and the operation leader, check the heart rate and blood pressure of Dieu Nhi. At 7:30 a.m., the surgical team make the final checks before commencing the operation.

Doctors closely monitor the health status of each baby on the screen during the operation. The period of anesthesia, Dieu Nhi is inherently weaker than Truc Nhi, so she has to face some difficulties. Luckily, for more than 13 hours of surgery, the children were fine, all indicators were in safe areas.

During the period of anesthesia, Dieu Nhi appeared inherently weaker than Truc Nhi. Luckily, the children remained relatively stable throughout the surgery.

Doctor wears surgical magnifying glass, ensuring accuracy and safety for the children.

Doctors wear surgical magnifying glasses, ensuring accuracy and safety.

The first surgical cut is done at 9:51 a.m.Tran Van Duong, a doctor from the Department of Orthopedics and Trauma-Surgery of Cho Ray Hospital, the head of plastic surgery team, starts to gain muscle and open his abdomen to separate the two babies. The General Surgery team went on to investigate the intestines and implemented a planned calculation for dividing the intestinal part.

The first surgical cut is done at 9:51 a.m.

Tran Van Duong, a doctor from the Department of Orthopedics and Trauma-Surgery of Cho Ray Hospital, heading the plastic surgery team, cuts open the belly to separate the two babies, with the General Surgery team carefully determining the separation of intestines.

Surgeons carefully observe the patients abdominal cavity through an ultrasound screen. Imaging tests have been performed many times, but doctors are not subjective.

Surgeons carefully observe the patient's abdominal cavity via an ultrasound screen.

At 2:07 p.m., doctors and nurses celebrate after separating the two girls. Each child is later taken to a separate operating table.

At 2:07 p.m., doctors and nurses celebrate the successful decoupling of the two girls.

Truc Nhi, a girl marked with a red paper, is taken to the ultra-clean air in operating room to continue the plastic surgery process as soon as she was separated from her twin sister. Dieu Nhi stayed at the operating room at the beginning, and the doctors continued to perform other operations.When splitting the two grandchildren, the doctors decided to keep the part of the ileum in common, the small ileum and the right ileum for Truc Nhi. Dieu Nhi is shaping these parts.

Truc Nhi is transferred to a separate operating room to continue plastic surgery while her sister Dieu Nhi receives treatment in situ. When splitting the twins, doctors decided to assign the common ileum, ileocecal valve and half of the right colon to Truc Nhi and create artificial parts for Dieu Nhi.

The surgery is over at 6:45 p.m. Doctors have completed the process of splitting and reconstructing, arranging defective organs and organs for the two babies. Truc Nhis parents and Dieu Nhi (left) broke up when picking up their children at the operating room door.The journey to recover and perfect the body is still very long ahead, Dr. Dinh said right after the end of the surgery. Professor, doctor Tran Dong A, 79, the leader of many twins separated cases in Vietnam, said: The success of todays surgery marks a new milestone in their lives, and also with Vietnams health sector is flourishing .

The parents (first and second left) are happy to embrace their baby girls once surgery concluded at 6:45 p.m. "The journey to full recovery is still long," Dinh confirmed.

Tran Dong A, the 79-year-old doctor having separated many twins in Vietnam, said: "The success of today's surgery marks a new milestone in their lives, and signals that Vietnam's health sector is thriving."

The twins regained consciousness on Thursday morning. They continue to undergo ventilation support and pain relieve medication. A hospital representative said that the babies only had mild fever due to inflammation post surgery, a normal body reaction, and are in stable conditions.

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