Doctors start marathon bid to part conjoined twins

The 16-strong team was on “tenterhooks” over the delicate bid to separate Trishna and Krishna, aged two, which will take about 16 hours, plastic surgeon Tony Holmes told reporters at Melbourne's Royal Children's Hospital.

“It is a stressful time for any group of surgeons with this sort of case. They only come along really once in a lifetime and I think everybody has been on tenterhooks,” he said.

Doctors began at 10:00 a.m. (2300 GMT Sunday) by cutting through the bone which joins the girls via the top of the head and were working to separate the connected section of brain and blood vessels.

“The unknown... is what actually happens when you separate finally the cerebral circulations, because that is a change in haemodynamics (blood movement) so the pressures will be different in each twin,” Holmes said.

“It's over those few early minutes when the pressures equilibrate in the brain, they're the things that we're worried about.

“But the children are prepared as well as could possibly be and we're cautiously optimistic that everything is going particularly well.”

By late afternoon the girls were still joined at the brain and at a bone bridge between their skulls, but the hospital's head of surgery, Leo Donnan, said he was pleased with the progress.

“I think everything is going really very well at the moment,” he said.

“Separation is still some way off. It's a long process of dividing the girls' brains so that they have their own tissue and their own identity.

“The girls' brain is going to be separated and then there is work that needs to be done on the bony structures around the brain.

“Then the girls will be physically separated at that point.”

The whole procedure is expected to finish at around midnight.

The girls, who were placed in a Dhaka orphanage at birth, were close to death when they arrived in Australia two years ago but both are now thriving after undergoing a series of preparatory operations.

The Children First Foundation (CFF) flew the girls to Australia because of poor separation survival rates in their native Bangladesh, where only two children have survived four operations in recent years.

Separating conjoined twins is a notoriously difficult procedure, with attempts in Britain and Bangladesh both failing over the past year, although Saudi doctors successfully divided a pair of Egyptian brothers in February.

In one of the best known cases, Singapore doctors in 2003 failed in an attempt to separate adult twins -- Iranian law graduates Laleh and Ladan Bijani, 29 -- who died from severe blood loss after 52 hours of surgery.

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