Surgeons have separated conjoined twins Krishna and Trishna in a marathon operation at Melbourne's Royal Children’s Hospital.
After more than 27 hours of separation surgery, plastic surgeons at Melbourne’s Royal Children’s Hospital have moved in to work on the Bangladeshi girls, aged two years and 11 months.
The hospital’s head of surgery Leo Donnan praised his doctors, who he said had worked seamlessly to separate the girls.
Surgeons Andrew Greensmith and Tony Holmes operate to separate the twins.
Surgeons Andrew Greensmith and Tony Holmes operate to separate the twins. Photo: Royal Children's Hospital
‘‘This is a once-in-a-lifetime operation that teams would do,’’ Mr Donnan told reporters outside the hospital.
''There's relief and it's nice to know we're on to the next stage rather than the previous stage we were at.''
‘‘Everything we have done has gone successfully,’’ Mr Donnan said.
‘‘It was a surreal moment when the pair was separated. And relief. But everyone realised there was a long way to go,’’ he said.
‘‘The girls' physiological condition has improved over the operations, but their bodies now have to recover.
‘‘Everything is in place for the best possible outcome.''
With the plastic surgeons completing the surgical work, Mr Donnan declined to say when the operation would be declared finished.
‘‘I’m not going to put any timeframe on it,’’ he said.
‘‘However long it takes is how long it takes.’’
The reconstructive surgery is expected to take a number of hours.
Earlier, as the surgery neared the 24-hour mark, Ian McKenzie, the hospital’s director of anaesthesia, emerged from theatre at 8am to report that "the kids are going very well" and but were still to be fully separated.
The operation was initially expected to take about 16 hours. The longest operation to separate conjoined twins joined at the head took four days in April this year in Singapore.
Dr McKenzie said that while progress might appear slow, it was "very fiddly work" and the operation was going "better in some ways" than expected. The girls’ conditions had strengthened as the operation proceeded, he said.
"A lot of the things we were worrying about haven’t happened," he said, but added "it’s not over yet".
"You’ve still got potential for life-threatening things happening."
He said concerns over problems with Krishna’s kidney had eased.
The Bangladeshi orphans were given just a 25 per cent chance of making it through the operation without harm. The hospital’s experts considered some level of brain damage a 50 per cent chance, and death was also a significant possibility.
Although he was not able to predict when the surgery would be finished, he said that was not a sign surgeons were encountering dangerous complications.
‘‘The twins are actually in better condition because the degree of separation has increased. The problem of their circulation affecting one another is actually less,’’ he said.
‘‘The brain is essentially disconnected and the tissue that is still connecting is fibrous tissue with veinous blood vessels in it. The brain tissue is disconnected and the bone tissue is disconnected.
‘‘The more they are disconnected the more we can treat them as individuals. Previously there was always the worry that if you treat one it could go in the wrong direction for the other.’’
Dr McKenzie said the handover to the cranio-facial plastic surgery team was ‘‘getting pretty close.’’
‘‘That is a critical part of the surgery ... There’s quite a lot of steps in that, and they each sound pretty simple, but they’ve each got their own issues.
‘‘Then creating a solid cap over that will be important, and then closing the skin over that. There’s quite a lot of steps in that, and they each sound pretty simple, but they’ve each got their own issues.
While he was still optimistic about the outcome of the marathon surgery, he said ‘‘we’re keeping the cork on the champagne’’.
‘‘Everyone is focusing on the separation point, but that’s going to be the start of a recovery phase which has still got potentially life-threatening complications.’’
‘‘So far so good, but there is still a long way to go.’'
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