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Separation of conjoined twins taking time -

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Separation of conjoined twins taking time

Simon Lauder reported this story on Tuesday, November 17, 2009 12:21:00

ELEANOR HALL: To Melbourne now and it's taking much longer than the doctors estimated but the
surgery to separate the conjoined Bangladeshi twins Krishna and Trishna is, in some respects,
turning out better than expected.

The orphan girls have been in surgery since yesterday morning but the operation is now in its final
stages and their doctors say they are already responding well to their new independence.

In Melbourne, Simon Lauder reports.

SIMON LAUDER: The operation was expected to take about 16 hours but as it stretched through the
night, anaesthetist Dr Ian McKenzie says the team at the Royal Children's Hospital needed a boost.

IAN MCKENZIE: We had some music from about three o'clock in the morning through to about six
o'clock. I think that stuff that I'm willing to listen to but not my favourite - a sort of light

SIMON LAUDER: Dr McKenzie says the team of nurses, anaesthetists and surgeons underestimated how
long it would take to separate the twins.

IAN MCKENZIE: It is very fiddly. Like we had that one, we keep referring to that operation whenever
that was, six months, a year ago which took 20 hours and that had less to it as it turns out than
this. We thought it might have more to it but that, 'cause it took a long time and it is a similar
sort of surgery, and that is that neurosurgical component where you just have to meticulously get
the tissues apart with the minimum of damage.

SIMON LAUDER: The twin's brains have been separated and so has their bone. All that linked the
twins when Dr McKenzie spoke to the media this morning was some fibrous tissue and some blood
vessels. He's expecting to be called back into the theatre as soon as the separation is complete
but he's given up guessing when that will be.

IAN MCKENZIE: The consultant neurosurgeon who turned and said "we'll be ready for the plastic
surgeon in two hours" and everyone laughed because honestly, that is what we have been saying since
six o'clock last night. It has got to be getting pretty close. We must be very close. It is
possible something could have been happening now but I might get back up there and they'll go
actually, it is going to be two hours.

SIMON LAUDER: One of the reasons the twins had to be separated is that their shared circulation was
affecting them unevenly. One twin had high blood pressure. The other had low blood pressure.

Doctors were reluctant to rely too heavily on medication which might affect both twins. Instead
they used gravity to alleviate the blood pressure problems.

There have also been several operations leading up to this one but doctors weren't able to predict
how their bodies would react once they were finally separated. There has also been concern for
Krishna's kidneys, which haven't been working.

Dr Ian McKenzie says each girls' blood pressure has been improving as they've become more separate
and there's evidence Krishna's kidneys are working again.

IAN MCKENZIE: Two o'clock in the morning it became apparent that some of the connections and even
late before midnight, her pressure has come up and the more they have disconnected her, the more
her pressure has come up so it has just become easier and easier to look after her and then, as I
say, her kidneys became apparent that they were starting to work again so that was great.

SIMON LAUDER: Trishna and Krishna were brought to Australia by the charity Children First. They are
now nearly three years old.

The chief executive of the Children First Foundation, Margaret Smith, says this morning's news is

MARGARET SMITH: One of the most beautiful things was to hear that Krishna's actually urinated. Very
funny when you think you get very excited about 5ml of wee but that is a very big plus because
Trishna has actually been urinating for Krishna for some time and they were just hoping her,
Krishna's kidneys would kick in and they have.

SIMON LAUDER: Moira Kelly from Children First is the guardian of the twins. Ms Smith says Moira
Kelly is holding up well, despite the operation lasting longer than expected.

MARGARET SMITH: She is very good today I believe. She was, sort of had a bit of a downtime last
night but she is certainly much better this morning and with all these little milestones that is
good news, that is really keeping her spirits up.

But she did want me to say to everybody that, thank you to everybody for their thoughts and prayers
because that, I think, has actually kept everybody here at Children First Foundation going and has
given her enormous strength and I am sure it is actually one of the catalysts for bringing the
girls through and giving the power to the surgeon's hands.

SIMON LAUDER: Before the operation began yesterday, neurosurgeon Wirginia Maixner warned that the
odds of it being a complete success are about the same as the risk that the girls will die and
there's a bigger chance they'll suffer brain damage.

Anaesthetist Dr Ian McKenzie says the riskiest part of the operation is over, but it's way too
early for any celebrations.

IAN MCKENZIE: Keep the cork on the champagne though. Everyone will be focussing on the actual
separation point but that is going to be the start of a recovery phase which has still got
potentially life threatening complications in the recovery phase.

SIMON LAUDER: When Krishna and Trishna are finally separated, the plastic surgeons will be called
back in to put a solid cap on the heads and put skin over the top.

Dr McKenzie says that phase is also risky.

IAN MCKENZIE: The risk of infection is actually potentially a life threatening thing over the next
days or weeks.

SIMON LAUDER: When this operation ends, the next wait will be to see whether Trishna and Krishna's
brain function is affected and that could be another week.

ELEANOR HALL: Simon Lauder in Melbourne.