Surgeons Break Down Separating Conjoined Twins | WIRED

meet aaron and abby they're craniopagus twins which means they're joined together by the head these surgeons successfully separated them so how do they do it one of the biggest challenges with separating conjoined twins when they're conjoined at the head is making sure that each brain has sufficient blood supply to it and sufficient drainage away from the brain and that really becomes in some ways the whole shooting match i'm dr jesse taylor and i'm the chief of plastic surgery at the children's hospital of philadelphia i'm gregory hoyer i'm a pediatric neurosurgeon at the children's hospital of philadelphia we're going to walk you through the tools we use to separate conjoined twins [Music] abby and aaron are connected like no other twins i think one of the hidden innovations in the approach we took was rather than just figure out how to separate them how do we change how they're connected how do we help ourselves before we do the actual separation one of the things we we're trying to do is use what we call the biological matrix to gradually pull the twins apart using force instead of just chopping them apart which is a grotesque way of saying what surgeons have done for over 50 years the biological matrix is how cells blood vessels and tissues work together to heal the body after an injury using this principle along with these four tools allowed surgeons to separate abby and aaron this is a model of the first ct scan that we got of the girls as they were conjoined and what it showed us is that they were connected by bone and then the covering of the brain obviously they were missing twice as much skin and subcutaneous tissue as would be on the top of your head the second thing about the models were we could turn them and look at where those veins came in to the head one of the major challenges of the surgery was how we were going to handle a big vein in the head called the superior sagittal sinus and that's a vein that runs down the center of your head and most of the blood that goes to your brain runs through that sagittal sinus and into a part called the transverse sinus right sort of where if you are wearing a ball cap where that ball cap would rest in the back if you lose your vein in your arm your arm might swell it'll likely have another way for the blood to come back from your arm in the brain because we're talking about a closed structure if the blood isn't able to come back from the brain you'll have a stroke before the twins were separated the team used distraction osteogenesis to further push apart the twins at their connection two unique things about distraction one is by slowly pulling bone apart the body lays down bone in between so it actually is a form of tissue engineering of bone second interesting thing about distraction is the side effect of bony distraction is changing the shape of the soft tissues brain blood vessels dura skin at the same time that you're changing the shape or configuration of the bone we got together with the engineers from depuy cynthia's which is a subsidiary of johnson johnson in design these modified helmets that fit on the tops of each of the two kids heads and then in between the two modified helmets were a series of three machine screws that were about a half inch thick the device itself the helmets plus the screws weighed maybe two pounds and there was a step before we placed the halo devices on them so we created a soft channel all the way around them to give those devices a bit of a mechanical advantage although we're using things that we normally do in the or and sort of adapting and changing them this is a product that only fit these twins and so it went back and forth until we could see what was working and ultimately the pressure that the screw was placing on the skulls to pull the skulls apart exceeded the perfusion pressure of the skin which led to skin ulcers we ultimately abandoned the distraction device [Music] after that we went to a custom it really looks very similar to a hose clamp and what a hose clamp is is a band that's got notches so that as you turn a screw on the band it decreases the circumference of the band itself and that was made out of a very inelastic rubber so that there was a bit of give but not much the distractors were on for about five weeks and then the contraction device was on for about four weeks the detractor pulled the twins apart by 25 millimeters or about an inch and the band further constricted their shared space by about 30 millimeters this realigned the twins and help decrease the complexity of the surgery navigation system is something we use routinely for brain tumors and for people who aren't doing brain surgeon which i guess is most people in the world what navigation is an analogous to the gps in your car that gps isn't the exact location of your car is but it shows you on a map where your car it's a representation and what that allows is we're then able to put a pointer and i can see on the screen which will be right next to me where we are in the brain so that we get some level of safety as to where we are so it never is a stop see where we are it's a constant reassurance during the operation process so when we started the operation the twins were laying on their sides in one direction and we opened that side and we started to dissect through the brain on that side when we got to the place where we thought we were about halfway through we then flipped the twins onto the opposite side and began operating from that opposite side so the surgical navigation as we would point the wand would confirm to us that yes we're headed towards that cleavage point that we had already opened on the other side so that was another way that it it just allowed us to kind of confirm that we were going in the direction we wanted to go in 2017 the twins were successfully separated after 11 hours in surgery abby and aaron were the third set of conjoined twins that dr taylor and dr hoyer have separated so if i had a wish it would be that we could start our process of changing the connection between the twins in utero where there's immensely more plasticity to the brain and the soft tissues if you could sneak into the womb with some endoscopes and put a rubber band in between the area of connection and that rubber band had just enough force to not exceed the perfusion pressure of the tissues but at the same time begin to constrict that connectivity to me that something like that is going to be the ultimate answer to this problem the morbidity from doing the surgery the way it's currently done it really is massive if i take one step back we're in front of the camera right now we're the ones talking about their separation there was an army of people so an anesthesia team a great rehab team a great nursing team ultimately what we're trying to do isn't necessarily innovate in surgery it's to do better for our patients but not for innovation's sake we're doing innovation to make kids do better so it all comes back to a quote of our boss dr adzic if you save a child you save a lifetime and so if you can't get geeked up over fixing uh newborn babies and having them doing better after your surgery then then you're in the wrong business [Music] you

Channel: WIRED

Views: 682,740

Keywords: conjoined twins, conjoined twins separation, conjoined twins surgery, craniopagus twins, dr. gregory heuer, dr. jesse taylor, erin and abby delaney, how doctors separate twins, how they separate conjoined twins, how to separate conjoined twins, separating conjoined twins, separating twins, siamese twins, surgery for conjoined twins, twins, twins surgery, wired, wired twins, wired twins surgery

Id: 6v-b4SELdnk

Length: 8min 1sec (481 seconds)

Published: Tue Jul 26 2022