The Challenges of Separation Surgery

ByABC News
January 3, 2007, 12:27 PM

Jan. 3, 2007— -- An operation today expected to take several hours will hopefully lead to the safe separation of 5-month-old conjoined twins Abygail and Madysen Fitterer, of Bismarck, N.D.

But for the surgeons and medical teams at the Mayo Clinic, preparations for the operation have been months in the making.

In fact, a series of simulations and dry runs has likely preceded today's operation -- the equivalent of dress rehearsals for this remarkable performance.

"Right away, we know that there has been a tremendous amount of work and preparation for today's surgery," said Dr. Kurt Newman, surgeon in chief at the Children's National Medical Center in Washington, D.C.

Newman has firsthand experience surgically separating conjoined twins. Last year, he was part of a surgical team that successfully performed such an operation on a pair of twin boys from Wisconsin. In June of 2004, he was also one of the surgeons who separated conjoined Virginian girls.

"There is a lot that is known now about what has to be done, and everyone has probably been prepared," he said. "But it's a bit like in sports, where there's nothing quite like entering the stadium or arena when it's game time."

In addition to the complexities normally associated with surgery, procedures to separate conjoined twins come with their own set of considerations.

"The first big deal is to get the family situated and set and get the babies into the operating room," Newman said. "As you move into the operating room environment, the anesthetist will get the babies intubated and asleep."

This step, he said, presents a very complicated set of parameters. Each baby needs enough anesthesia to get through the surgery painlessly. Too much, however, could put the life of one or both infants in danger.

And since the babies are connected, administering the proper level of anesthesia to both becomes a delicate balancing act.

"The goal is to get both babies asleep, stable and anesthetized during what will likely be a long operation," Newman said.