Conjoined Twins Successfully Separated

July 19, 2020 | Thao Tran

Original Vietnamese article by Huu Khoa & Anh Thu from VnExpress on July 16, 2020

English translation by Uyen Phuong Tran

Graphics by Nhi Tran

An over 13-hour Operation to Separate The Conjoined Twin Sisters

93 doctors and medical experts of Ho Chi Minh City managed to successfully separate and reconstruct the lower bodies of Trúc Nhi and Diệu Nhi in a surgery lasting 13 hours and 40 minutes.

At 6 am on July 15th, the two 13-month-old Diệu Nhi and Trúc Nhi, who were born attached at the pelvic and abdominal areas, were transferred from the NICU to the operation theater number 11 of City Children’s Hospital. Here, 93 doctors, medical experts, and nurses from various Southern hospitals were assigned into 11 surgical teams for the major separation surgery.

major separation surgery
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The ischiopagus tetrapus twins were conjoined at the pelvic and abdominal areas, which is a rare phenomenon accounting for only six percent of conjoined twins. In terms of the digestive system, the twins shared a part of the ileum, a colon, and they only had one anus. In terms of the urinary system, the twins had two bladders situated in two sides of the shared abdomen. Each bladder was connected to two ureters belonged to each twin instead of coming from the same twin. Their pelvic frames lined up to form a circle.

distinguish the two twins

To distinguish the two twins and avoid mistakes on the personnel and surgical equipment, the nurses sticked a piece of red paper on Trúc Nhi’s forehead (left) and a piece of blue paper on Diệu Nhi’s.

Operation to Separate The Conjoined Twin Sisters
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Before anesthesia was administered, the twins were conscious, interacted well, and even played on the gurney.

To ensure their psychological wellness, two nurses were assigned to provide care and comfort pre-anesthetics.

Separate The Conjoined Twin Sisters
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Anesthetic administration took nearly 3 hours, starting at 6:30 am. Anesthetic technicians calculated the dosage for each of the twins based on their own physical conditions. Before separation, their bodies were still conjoined, resulting in anesthetic circulation between the two. Therefore, the anesthetic team had to be extremely careful.

Conjoined Twin Sisters
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Trương Quang Định, MD-PhD, Director of Ho Chi Minh City Children’s Hospital (wearing the stethoscope), the chief conductor and surgeon, personally listened to Diệu Nhi’s heartbeats and took her blood pressure before making the first incision. He paid undivided attention to every breath of hers.

At 7:30 am, the surgical teams consulted for the last time before the operation to re-confirm the procedures and collaboration stages with the other teams.

The doctors strictly monitored each twin’s vital signs on screens both during and after the surgery. During the anesthetic administration, Diệu Nhi had some minor difficulties as she has always been not as healthy as Trúc Nhi. Fortunately, both of them were stable with all vital signs in the safe range during the whole surgery of 13 hours.

The surgeon wore spectacles with surgical loupes to ensure the precision and safety for the twins.

The first incisions that started the life-changing journey for the two girls were by Dr. Trương Quang Định at 9:51am.

Surgery team
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Then, Dr. Trần Văn Dương from Orthopedic Department of Chợ Rẫy Hospital in charge of the Reconstruction team started muscle relaxation and opened the abdomen to separate the twins. The General Surgery team investigated the intestines and carried out the procedures to divide the intestines as planned.

twins were successfully separated
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Surgeons closely observed the abdominal cavity on the ultrasound screen monitor. Although pre-operative imaging diagnostics had been conducted several times, the doctors remained cautious.

At 2:07pm, the doctors were overjoyed as the twins were successfully separated. Each of them was then placed on their own operating tables. At this very moment, the girls’ normal, independent lives began.

operation theater
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After being separated from her twin sister, Trúc Nhi, the girl with the red marker, was immediately transferred to the extremely sterile operation theater number 12 for reconstruction surgery. Diệu Nhi remained in the original operation theater and also went on with other surgeries.

separating the twins
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In separating the twins, the doctors decided to leave the shared ileum, the ileocecal valve, and half of the left colon for Trúc Nhi. Diệu Nhi had those organs reconstructed.

At 6:45pm, the operation was completed. The doctors had finished the separation, reconstruction, and rearrangement of all the affected organs for the twin sisters. Diệu Nhi and Trúc Nhi’s parents (left) were overwhelmed with joy as they welcomed their children at the entrance of the operation theater.

 twin separation surgeries in Vietnam
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‘There will be a long recovery and physical improvement journey ahead,’ said Dr. Định after the operation. Trần Đông A, MD-PhD, the 79-year-old doctor who has directed many twin separation surgeries in Vietnam stressed, ‘The success of this operation marked a new milestone in both the twins’ lives and the ever growing Vietnamese healthcare.’

  In translating this article into English, we did not localize the names in order to pay respect to the Vietnamese doctors and the ordeal the young twins went through. We wish them both a speedy recovery and a lifetime of happiness.