Inquest hears of conjoined twins' death

A US surgeon yesterday told a coroner's inquest into the deaths of 29-year-old Iranian conjoined twins that the surgical team separating the sisters could have stopped the operation when the first hint emerged that the women's blood flow would be unpredictable.

Dr. Ben Carson's comments contrasted with those of lead surgeon Dr. Keith Goh, who said earlier this week that surgeons felt they were "at the point of no return" when previously undetected dormant blood vessels in Ladan and Laleh Bijani, who were joined at the head, opened up and started bleeding uncontrollably.

Carson, who was speaking by video linkup from Baltimore, Maryland on the last day of the inquest, said that the surgery could have been stopped when these dormant blood vessels were first detected. According to Carson, these blood vessels started filling with blood after the separation was under way and were detected before uncontrollable bleeding started.

"It would have been possible to stop the surgery at that point," said Carson, who is head of pediatric neurosurgery at Johns Hopkins University.

He said that if the surgery was stopped then, the sisters would have faced risks of stroke, infection or heart attack, but added, "If we knew then what we knew today, we probably would have taken those risks."

The sisters died 90 minutes apart from massive blood loss on July 8 at the end of an unprecedented 50-hour operation by a team of 28 doctors and about 100 medical assistants.

Outside the court, Goh acknowledged that there were "minor differences in perspective" within the surgical team, but everyone had agreed to continue at the time.

"It was a highly charged, very intense atmosphere and very critical decisions had to be made then and there," Goh told reporters.

"Nobody dropped instruments, unscrubbed and walked out," he said. "The team was together, there was a consensus and we were all in this together to the end trying to save the girls."

On Wednesday, Goh told the court that the team had to press ahead with the operation to stop the bleeding.

"We felt we were at the point of no return," Goh had said. "Continuing was the only chance we had to stop the bleeding and save the lives of the girls."

Goh also played a videotape for the court showing the twins urging him to continue operating regardless of any complications.

Goh said Thursday that the operation raises the issue of the changing standards doctors face when it comes to patients' wishes.

"We saw very clearly the desire for the twins to have freedom and live independent lives," he said.

"I hope that the people in the world who will listen to this will draw some inspiration that sometimes when you want something badly enough -- especially something like freedom -- then you have to be willing to risk your life for it," he added.

Forensic pathologist Dr. Paul Chui told the court that doctors had obtained "a very high standard of consent" from the twins -- who were both law graduates -- through the videotape and consent forms signed by witnesses.

Chui added it would have been very risky to stop the surgery because the twins would have been joined only by a thin "bridge" of tissue which could have been torn if their heads moved.

Carson agreed with Goh and other experts' testimony that no test could have detected the dormant blood vessels before surgery.

The complications were unavoidable, he said.

"The amount of blood that is drained from the brain in just a few minutes can be equal to the entire blood volume of the body," he said.