Siamese Twins

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SURGICAL PLAN (Talia & Taleen)

TIME OF REHEARSAL OPERATION:	Tuesday, 30 September 2003 @ 1600 hours
DATE OF SEPARATION SURGERY:	Saturday, 04 October 2003
TIME OF SEPARATION SURGERY:	0730 hours

SURGICAL TEAMS INVOLVED:

PHASE ONE:
This will be the anesthesia phase.
Team I + Dr. Abdullah Al Rabeeah
This phase will last 1½ - 2 hours.

PHASE TWO:

This will be the cleaning and sterilization of the skin and positioning.
Team II (Dr. Abdullah Al Rabeeah & Dr. Saud Al Jadaan)
Team IV
This phase will last ½ hour.

PHASE THREE:

This will be the skin mapping and opening.
Dr. Abdullah Al Rabeeah + Team III
This will last ½ hour.

PHASE FOUR:

This will be the liver separation.
Team II – Dr. Abdullah Al Rabeeah + Dr. Saud Al Jadaan + Dr. Wael O’Hali
Dr. Mohammed Al Namshan, Dr. Solaiman Bin Yahib (alternating).
This will last 2 hours.

PHASE FIVE:

This will be the separation of xiphoid and ribs and abdominal wall.
Team II – Dr. Abdullah Al Rabeeah + Dr. Abdullah Al Thunayan
Dr. Wael Al O’Hali, Dr. Stanley Crankston (alternating)
This will last 1 hour.

PHASE SIX:

After separation and reconstruction.
Two Teams + Two tables:

A B

Dr. Manaf Al Azzawi Dr. Abdullah Al Rabeeah Dr. Abdullah Al Thunayan

Dr. Wael Al O’Hali Dr. Saud Al Jadaan

Dr. Mohammed Al Namshan Dr. Stanley Crankston Dr. Solaiman Bin Yahib

This phase will last 1½ - 2 hours.

PHASE SEVEN:

Dressing and transfer to PICU.
Possible extubation.

EQUIPMENT:

Cusa
Argon laser
Diathermy - unipolar (two sets)
Vascular sutures prolene 410/510
Vascular set
General pediatric surgery set
Foley catheters size 6F and 8F
Hemo clips – small, medium and large
Headlight

LIVER SEPARATION:

The plan is to localize the blood supply of the liver from each twin and bile ducts.
The line of fusion is to be identified, and a catheter is to be passed behind the liver to mark the site.
The separation will be conducted to minimize blood loss using ultrasound dissection and Argon laser with control of bleeding with unipolar diathermy.
After completing each segment of the liver, the edges will be approximated with absorbable sutures 3/0 (liver needle).

CHEST AND ABDOMINAL WALL SEPARATION:

This will be done with plans not to turn the twins upside down.

RECONSTRUCTION OF ABDOMINAL WALL DEFECT AND PECTUS CARINATUM:

This will be done in conjunction with Plastic Surgery. The teams plan to avoid using and prosthetic tissue for coverage and also to correct the chest wall deformity, if the medical condition of the twins allows and there is no pressure on the underlying structures.