A 3D model of the binoculars, a 27-hour surgery, a multidisciplinary medical team
Elizabeth and Mary Akwe were born in Cameroon in July 2020 as conjoined twins. The babies shared pelvis and some organs and many muscles and tissues in common, this situation made the separation operation very complicated. Her case required the expertise of a world-class hospital using the latest medical technologies and the expertise of a multidisciplinary team. It took weeks of complex planning to properly prepare for the separation operation. The University of Acăbadem Biodesign Center created a 3D model of the binoculars that allowed surgeons to see clearly the existing connections between the two bodies and the extra volume of skin needed to cover the separation wounds. Elizabeth and Mary were successfully separated after an operation that lasted 27 hours. Here’s the story of a very happy breakup that both achieved physical independence.
Caroline and Richard Akwe are a happy couple from Cameroon. Married for three years, they impatiently awaited the birth of their twins. On the day of the birth, the then 26-year-old mother and her babies were in good health, except that the twins were conjoined … The couple was grateful because both babies were born alive, but daily life continues very difficult, breastfeeding the Gemini got very complicated.
“I suffered a lot while breastfeeding because they were stuck together”
The twins’ father, Richard Akwe, 28, says: “We were very afraid that our babies would not be able to move around freely. Due to her position, her mother could only breastfeed one baby at a time, our other daughter’s screams melted our hearts. Our binoculars are a gift to us and we are committed to taking care of them as best we can.” Caroline Akwe adds: “Despite all the difficulties, I breastfed my babies for a year. We have never given up hope that the two will stay apart and stay healthy for each other. »
In fact, in order to have better living conditions, the twins must be separated by an operation that promises to be difficult. The only difference is that the medical infrastructure required for this procedure is not available on site. A message aims to give hope to parents who have also suffered from losing their jobs due to the pandemic. The Presidency of the Republic of Cameroon has declared that it takes over the treatment of Siamese babies abroad. A few weeks later, the twins were admitted to Acıbadem Altunizade Hospital in Istanbul, Turkey, and preparations for the surgery began…
They had many physical and systemic connections
Elizabeth and Mary were born tied at the pelvis. They had many physical and systemic connections. The spinal cord and parts of the spine, the urinary tract, the end of the digestive system, the reproductive system, the nervous and vascular systems located in the lower abdomen and at the waist level were closely connected. Arriving at Acıbadem Altunizade Hospital at the age of 9 months, Mary and Elizabeth met for the first time the medical team that will accompany them in this human adventure for 7 months.
A major surgical procedure
Siamese twin separation surgery was not a common operation. A multidisciplinary medical team made up of specialists in pediatric surgery, anesthesia, plastic surgery, pediatric neurosurgery, radiology, urology, physical therapy and rehabilitation, and cardiovascular surgeons meet to plan the twins’ separation. The preparation for this multidisciplinary operation took about 7 months. To minimize risk, a 3D model of the binoculars was created prior to the operation to allow the doctors to accurately plan their consecutive surgeries on day “D”. The council of doctors involved in this procedure met to discuss the course of the operation and assess possible risks.
The overriding goal was for the two twins to stay alive. Their 3D model was created thanks to preoperative radiological and angiographic modeling of the twins, so that their motor and systemic functions would not be impaired after the operation. Because each of the babies had specific problems. For days, the 3D model of the conjoined twins, made by the Biodesign Center of the University of Acăbadem, was examined by the doctors and made a great contribution to the course of the operation.
The first preparatory operation was to expand the skin to obtain sufficient volume to cover the separation of the bodies. This process lasted a few months, in addition to preparing for the separation operation.
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With the calendar showing August 12, 2021, Mary and Elizabeth were admitted to the block at 8:00 a.m.
Pediatric neurosurgeon Professor Memet Özek and his team were the first to start the procedure: “As a neurosurgical team, we started by separating the spinal cord, alveoli, nerve endings and the common pelvic bones. I remember the operation was going to be complicated in every way; In fact, bone marrow surgeries are performed while the patient is lying prone. Impossible position with binoculars. For the first time in forty years of experience, I performed spinal cord surgery with patients lying on their side. We are very pleased with the success of the operation, the neurological abilities of both babies are well preserved. For the first time in their lives, Mary and Elizabeth independently took their first steps at AcÄ±badem Hospital. I would like to acknowledge the efforts of the physical therapy team who have been working with the two girls for more than six hours each day for the past few weeks to get them to sit up, move and walk as quickly as possible. »
Professor Burak Tander, specialist in pediatric surgery, adds: “The twins share the urinary tract, rectum, anus and some delicate veins. All the muscles of the lower abdomen and back were common. Our goal from the beginning was to divide all tissues in half so that every baby could acquire the functions and reflexes of every organ and muscle in the human body, even if only half. Also, we wanted each of them to have the chance to have children in the future. One of the girls didn’t have a vagina, the other had rectal problems, and they both shared the same uterus. During the operation, an enlarged intestine was used to create a vagina for the first baby, and we sewed up the rectum of the second. The digestive system, reproductive system, nervous system, and blood vessels were shared between the two children. The whole team worked on the 3D model we made at the university to make the cutting process perfect. When she woke up after the operation, Mary saw Elizabeth in front of her on another bed, she was smiling. It was an unforgettable moment for the entire medical team. »
For his part, Professor Hakan AÄŸÄ±r, Specialist in Plastic and Reconstructive Surgery, said: “My team and I calculated the volume of skin needed to cover the separation wounds immediately after the twins arrived at the hospital. AcÄ±badem. While my colleagues worked on the 3D model to determine the possible dividing lines, we both had pouches inserted under the skin of both girls and filled them with a tiny amount of liquid daily to stretch their skin. This operation was the first preparatory step for the separation operation. In the second phase, after Professor Memet Özek and Professor Burak Tander’s teams withdrew from the operating room, we took on the task of “closing wounds”. Reconstructive surgeries left tiny scars on Marie and Elizabeth’s bodies that will fade over time. After the operation, supported by the competent members of the intensive care team, we created exemplary conditions for rapid wound healing and, together with the infectiology team, decided on the dosage of the medication to be administered in order to avoid infections. I thank them all for their commitment. »
The anesthetist, assistant professor Dr. Zehra Serpil Ustalar, stated: “Our duty as anesthesia team was to ensure that the twins were euthanized and awakened in the safest way to preserve their health and to create the best conditions to facilitate the surgeons’ work during the.” Surgery. We started the anesthesia process by preparing all the equipment in two different colors, and we coded drugs, machines and even beds with these colors to avoid confusion. Caring for the twins during the 27-hour separation surgery was a real challenge. Thanks to the professionalism of all the teams, the use of advanced medical technologies and the training we had on the 3D model, Mary and Elizabeth are now separated and in good health. The twins have adjusted to their bodies and are growing together quickly. I am happy to be part of the medical team that accomplished this feat. Seeing Mary and Elizabeth happily singing and dancing with their mother is the greatest reward.
Pediatric intensive care specialist Professor Agop ÇÄ±tak summarizes the intensive care phase as follows: “The process of surgically separating the twins was very long and complex. The operation required intensive postoperative care and close monitoring of all the babies’ vital signs. My team and I have considered all the possibilities that Mary and Elizabeth might face after the separation and we have prepared all the medication, blood, equipment and ICU bed needs accordingly. The nurses treated Mary and Elizabeth for several weeks, and my fellow surgeons followed the twins’ recovery daily via screens connected to the cameras installed in the ICU. Long operations weaken the immune system and increase the risk of infection – these measures taken by my team aim to keep our little patients as healthy as possible. After several days of rapid recovery, the two girls were woken up and taken off the ventilators. Mary and Elizabeth stayed in the pediatric intensive care unit for a few days in a room specially set up for them to live with their parents after ensuring their immunity was fully restored. »
The AcÄ±badem group wishes Mary and Elizabeth a long and happy life. Our doctors will follow up the twins regularly to meet any medical needs they may express as they grow up. To get a free second medical opinion from our experts, contact us via https://acibadem.fr/
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