Surgeons launch operation to separate conjoined twins

Iranian twins Ladan, left, and Laleh Bijani, who were born joined at the head, rest after a preoperative procedure in Singapore in this photo from last month. PHOTO: AP

Surgeons a marathon operation yesterday to separate a pair of 29-year-old Iranian twin sisters joined at the head -- a procedure that could kill one or both.

After a lifetime of compromises on everything from when to wake up each day to what career to pursue, Ladan and Laleh Bijani said they preferred to face the dangers of the surgery rather than continue living joined.

"If God wants us to live the rest of our lives as two separate, independent individuals, we will," Ladan said Saturday.

An team of 28 doctors and about 100 medical assistants will participate in the surgery, which will last at least 48 hours and could take four days.

"The twins were wheeled into the operating theater and the medical team is now administering anesthesia to the twins," said Dr. Prem Kumar, a spokesman at Singapore's Raffles Hospital.

The twins had said they wanted to walk into the operating room as a sign of courage, but they were brought in by wheelchair shortly after 10:00am because they were too tired to stand, Kumar said.

The operation will mark the first time surgeons have tried to separate adult craniopagus twins -- siblings born joined at the head -- since the procedure was first successfully performed in 1952.

"It's going to be a good day," the lead neurosurgeon Dr. Keith Goh told reporters as he arrived at the hospital yesterday morning. He said he and his wife spent the morning praying for the twins.

When asked about his mood as he entered the hospital yesterday, Dr. Benjamin Carson, one of six international experts assisting in the surgery, said one word: "Sunshine."

Ladan Saturday that she and her sister would spend the hours before the operation reading the Koran and performing ritual Muslim ablutions. "We feel closer to God that way," she said.

The sisters each have a 50-50 chance of survival, said Carson, a Johns Hopkins neurosurgeon from Baltimore, Maryland. But he said he expected the surgery to be a success.

The US$288,000 cost of the surgery is being underwritten by Raffles Hospital, and the doctors' fees are being waived.

The Bijani sisters, born in Firouzabad, southern Iran, in 1974, have separate brains that lie next to each other in a joined skull. Their heads are connected but their bodies are otherwise distinct.

The surgeons' biggest challenge will be dealing with a shared vein that drains blood from the women's brains. German doctors concluded in 1996 that the vein made surgery too dangerous.

The surgeons' first task was to remove a vein from one sister's leg that will be used as a graft to replace the shared vein, Kumar said. He did not say who the vein would be taken from.

Carson the veins to a city's road network, and said the surgeons had to identify traffic jams and create detours. The largest vein was the size of a finger, he said.