There is perhaps no surgical procedure more daunting or complex that the separation of conjoined twins, even with the use of advanced 3D technology. Not only is the surgery being performed on a tiny infant, which is always delicate and dangerous, but there really is no rule book for separating these children because they are often conjoined in completely unique ways. Most birth defects have standard procedures in place that surgical teams can use as a guideline. The defects may present in different ways, but the basic specialists and surgeries that need to be involved are usually the same. But conjoined twins are very often quite unique in what parts of the body are connected, what internal structures are connected and what dangers are present when determining how to separate them.
It is estimated that one in every two hundred thousand sets of twins could be born conjoined, so it is already an extremely rare phenomenon. Even rarer is a set of triplets being born with two of the three babies being conjoined, an occurrence that is so rare that there is a one in 50 million chance of it happening. The last time that this was reported in the United States was back in 1966. But in May of 2015 Catalina, Ximena and Scarlett Hernandez-Torres were born in Corpus Christi, Texas. Ximena and Scarlett were conjoined at the pelvis; however each girl has her own set of legs. This itself is also a rarity in conjoined births, with only six percent of them being born connected in this way.
Ximena and Scarlett share several vital organs, including their colon, their uterus and a single set of ovaries. The two girls each have their own bladders, however Ximena’s kidneys are attached to Scarlett’s bladder, and Scarlett’s kidneys are attached to Ximena’s bladder. Because they share the same colon, currently both girls are being fed using a feeding tube. When the two are separated, the doctors will need to reroute both girls’ kidneys to their correct bladders and will divide the colon between them. The procedure is expected to last between twelve to eighteen hours and involve several surgical teams, including pediatric surgeons, plastic surgeons, urologists and orthopedic specialists who will need to correct each girl’s pelvis.
The same technology that has been used to create 3D models of patients’ hearts or internal organs was used to generate an interactive 3D model of Ximena and Scarlett’s complicated internal anatomy. The doctors have used the virtual 3D model of the twins to simulate the surgery, so they know what needs to be separated and what complications may occur. Not only will this process speed up the various surgeries involved in the procedure, but it will make them safer for the patients and is easier for the doctor. Virtual surgical preplanning, using 3D assets generated by CT scans and MRI data, has seen a lot of use recently, as it allows doctors the chance to know exactly what they are going to see when they open a patient up.
Silvia Hernandez and her husband Raul were told that two of their daughters would be born conjoined just three months into their pregnancy, so the couple has been preparing for this day for well over a year. And while the doctors are very confident that the girls’ separation will be completely successful, that doesn’t mean it is any easier for their parents. Silvia, who is currently staying at a nearby Ronald McDonald House, has sadly not even been able to feed her daughters on her own yet, so the upcoming surgery is weighing hard on her.
“Since they were born, I have been waiting anxiously for them to be separated because I want to hold them separately in my arms and hold them close. But the closer the surgery day is getting, I don’t want it to happen. But of course I want it to happen so they can have a normal life. My daughters are in hands of God and his will will be done,” the girls’ mother Silvia Hernandez told CBS news.
The team of specialists being tasked with separating Ximena and Scarlett is being led by Dr. Haroon Patel from Driscoll Children’s Hospital in Corpus Christi, Texas. Most surgical procedures used to separate conjoined twins take months of pre-planning, but Ximena and Scarlett’s surgery will be especially complicated so Dr. Patel has spent nearly ten months preparing for it. The team was planning on the girls being separated last month; however, they came down with a respiratory infection that postponed it until this week. Still, the team is fully prepared for the surgery thanks to the use of advanced 3D software, so they believe that Scarlett and Ximena will be well enough to go home within three months.