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Surgeons Operate on Adult Conjoined Twins
Aired July 07, 2003 - 14:39 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
MILES O'BRIEN, CNN ANCHOR: Medical history being made at this very moment in Singapore, as a life-and-death surgery to separate 29- year-old conjoined twins reaches a critical stage. Doctors have finished rerouting a shared vein that draws blood from their brains, but the operation already into its second day, far from over. And surgeons remain cautiously optimistic, nevertheless.
CNN medical correspondent Dr. Sanjay Gupta happens to be a neurosurgeon, has been tracking this very closely, wishes he was there. We wish he was there to give us the play-by-play. But, for now, we're going to watch it from afar.
When we say it's at a critical phase, that makes it sound like there's an easy part. Nothing easy about this surgery, right?
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Right.
And it's never been done before on adults. So this is all sort of people sort of making history here, literally, as they go along.
O'BRIEN: All right, so bring us up to date.
GUPTA: OK.
O'BRIEN: Give us a sense. We have got some animation here which can help people understand. And I guess the key to remember is here, we have told you about conjoined twins before. The fact that they are adult is significant.
GUPTA: A big difference. Brains in adults don't rebound nearly as well, not nearly as resilient.
Take a look at the animation there. As you can tell now, this is the actual models of Ladan and Laleh Bijani. And as it rotates, you get a sense here of how they are conjoined. Go ahead and take away the skin. You see the skull as well conjoined, very thick bone near the back, Miles. They had a little bit of difficulty, we heard at the press conference, actually getting through some of that bone, even with their power tools.
Now, the brain itself conjoined, although the brain is actually separate. I think we're going to go ahead and stop there. And the reason I'm stopping there is, I want to point out this particular vein here. This is the vein that we've been talking so much about. Miles, you see one vein there. There should be two, one for each separate brain.
O'BRIEN: Oh sure.
GUPTA: So what in fact the surgeons did -- and, again, this is sort of making this up as they go along here -- what they did was, they actually took a vein from the leg of one of the twins and they actually sewed in it from here to here on the one twin.
O'BRIEN: Wow.
GUPTA: So you can see now, the vein -- big vein that we're talking about actually goes with the brain on the left and they actually essentially created another vein by taking a vein from the leg.
O'BRIEN: Wow.
GUPTA: And this, again, not been done before in this sort of situation.
O'BRIEN: It's -- right there, that's pretty amazing. Do you do a leak check? How do you know that it's working properly before you press on?
GUPTA: Yes, there's a lot of ways to actually test it. They actually take ultrasound and actually measure it to see if there's flow through that particular vein.
But, Miles, you bring up a really good point, because, if that vein becomes blocked, if it develops a clot inside of it, sort of game over as far as that vein goes. So what they have to do is actually give blood thinners at the same time to prevent that vein from clotting off. You can see the obvious problem there. They are performing surgery and giving blood thinners at the same time.
O'BRIEN: Oh, boy.
GUPTA: That can cause bleeding in the blame, exactly what they don't want.
O'BRIEN: Talk about walking a tightrope there.
Now that that has been done and, presumably, that check has gone OK, what's the next big sort of milestone for this surgery, which, by the way, we're talking about, what, three or four days, three days, right?
GUPTA: They are saying up to four days, the whole thing.
O'BRIEN: Isn't that amazing, four days in surgery?
GUPTA: Right.
O'BRIEN: And that, in and of itself, has got to be a tremendous thing for them to endure.
GUPTA: The surgeons. Obviously, this is going to be when the rubber hits the road, really, for them here, operating many, many hours at a stretch.
O'BRIEN: All right, so the next big milestone?
(CROSSTALK)
GUPTA: The next big milestone really here -- again, and you can tell the brain there -- I'm going to go ahead and -- if it will stop there -- basically, it is separating the brain. Wait, it has actually done it for itself.
O'BRIEN: OK.
GUPTA: But, basically, you have to separate the two lobes of the brain. Now, they have been fused together for 29 years. So you can imagine, like, it's almost like slowly dividing a very important piece of cheese. You cannot cut any of the cheese.
O'BRIEN: Right. Oh, there's a good -- that gives you a good angle there.
GUPTA: That's a good shot. That's right.
O'BRIEN: Now, how do you know, when you look at that, as a brain surgeon, are you able to tell which -- because -- talk about gray area, quite literally, the gray matter there. How do you know which brain cells are feeding which intellect?
GUPTA: That's an excellent question. And these two girls -- women, I should say -- make it even more interesting, because, in fact, on the right side of the brain -- I'm sorry -- the left side of the brain here, this woman over here, Ladan, actually wants to be an attorney.
The left side of the brain, which is presumably the part of the brain that's going to be the most affected, is responsible for language skills, certainly obviously important skills for an attorney. For the other twin, actually, the right side of the brain -- of her brain is going to be affected, obviously, as you can look at it just anatomically. She wants to be a journalist, the right side of the brain more responsible for creativity.
O'BRIEN: There's a bit of tragic irony in all of this.
GUPTA: There really is.
O'BRIEN: And there's a lot of those twists and turns. We're watching it very closely. When's the next update we're going to get?
(CROSSTALK)
GUPTA: I think we're going to get that within the next couple of hours. We're certainly going to keep an eye on that. Again, some of the critical phase of the operation, over this vein part that I showed you. They are working on splitting the brain now. That could take up to 10 hours to do at a stretch.
O'BRIEN: Wow.
GUPTA: Then, after that, there's going to be a lot of reconstructive aspects of this case. So it could be a couple of days still.
O'BRIEN: I know you haven't done one quite like this, but when you're operating on the brain like that -- and I know we're out of time -- but do you ever just have a moment of self-realization, that you go, I can't believe I'm doing this?
GUPTA: Well, I think the neurosurgeons I think universally feel that operating on the brain is one of the most gratifying things.
O'BRIEN: Really?
GUPTA: An operation like this, if it goes well, and these two twins do well, I think it going to be an extremely satisfying thing.
O'BRIEN: But, as you say, it's still elective.
GUPTA: It is elective.
O'BRIEN: And that has got to make it all the more...
GUPTA: It makes it more challenging in a way. This isn't life- saving. If someone dies in this case, where there's a 50/50 chase of it, it's going to be a huge loss.
O'BRIEN: Yes. The bar is a little higher than normal, isn't it?
GUPTA: That's right.
O'BRIEN: All right, Sanjay Gupta, fascinating.
(CROSSTALK)
GUPTA: Thanks.
O'BRIEN: Check in with us in a little bit, please.
GUPTA: I will, for sure.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired July 7, 2003 - 14:39 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
MILES O'BRIEN, CNN ANCHOR: Medical history being made at this very moment in Singapore, as a life-and-death surgery to separate 29- year-old conjoined twins reaches a critical stage. Doctors have finished rerouting a shared vein that draws blood from their brains, but the operation already into its second day, far from over. And surgeons remain cautiously optimistic, nevertheless.
CNN medical correspondent Dr. Sanjay Gupta happens to be a neurosurgeon, has been tracking this very closely, wishes he was there. We wish he was there to give us the play-by-play. But, for now, we're going to watch it from afar.
When we say it's at a critical phase, that makes it sound like there's an easy part. Nothing easy about this surgery, right?
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Right.
And it's never been done before on adults. So this is all sort of people sort of making history here, literally, as they go along.
O'BRIEN: All right, so bring us up to date.
GUPTA: OK.
O'BRIEN: Give us a sense. We have got some animation here which can help people understand. And I guess the key to remember is here, we have told you about conjoined twins before. The fact that they are adult is significant.
GUPTA: A big difference. Brains in adults don't rebound nearly as well, not nearly as resilient.
Take a look at the animation there. As you can tell now, this is the actual models of Ladan and Laleh Bijani. And as it rotates, you get a sense here of how they are conjoined. Go ahead and take away the skin. You see the skull as well conjoined, very thick bone near the back, Miles. They had a little bit of difficulty, we heard at the press conference, actually getting through some of that bone, even with their power tools.
Now, the brain itself conjoined, although the brain is actually separate. I think we're going to go ahead and stop there. And the reason I'm stopping there is, I want to point out this particular vein here. This is the vein that we've been talking so much about. Miles, you see one vein there. There should be two, one for each separate brain.
O'BRIEN: Oh sure.
GUPTA: So what in fact the surgeons did -- and, again, this is sort of making this up as they go along here -- what they did was, they actually took a vein from the leg of one of the twins and they actually sewed in it from here to here on the one twin.
O'BRIEN: Wow.
GUPTA: So you can see now, the vein -- big vein that we're talking about actually goes with the brain on the left and they actually essentially created another vein by taking a vein from the leg.
O'BRIEN: Wow.
GUPTA: And this, again, not been done before in this sort of situation.
O'BRIEN: It's -- right there, that's pretty amazing. Do you do a leak check? How do you know that it's working properly before you press on?
GUPTA: Yes, there's a lot of ways to actually test it. They actually take ultrasound and actually measure it to see if there's flow through that particular vein.
But, Miles, you bring up a really good point, because, if that vein becomes blocked, if it develops a clot inside of it, sort of game over as far as that vein goes. So what they have to do is actually give blood thinners at the same time to prevent that vein from clotting off. You can see the obvious problem there. They are performing surgery and giving blood thinners at the same time.
O'BRIEN: Oh, boy.
GUPTA: That can cause bleeding in the blame, exactly what they don't want.
O'BRIEN: Talk about walking a tightrope there.
Now that that has been done and, presumably, that check has gone OK, what's the next big sort of milestone for this surgery, which, by the way, we're talking about, what, three or four days, three days, right?
GUPTA: They are saying up to four days, the whole thing.
O'BRIEN: Isn't that amazing, four days in surgery?
GUPTA: Right.
O'BRIEN: And that, in and of itself, has got to be a tremendous thing for them to endure.
GUPTA: The surgeons. Obviously, this is going to be when the rubber hits the road, really, for them here, operating many, many hours at a stretch.
O'BRIEN: All right, so the next big milestone?
(CROSSTALK)
GUPTA: The next big milestone really here -- again, and you can tell the brain there -- I'm going to go ahead and -- if it will stop there -- basically, it is separating the brain. Wait, it has actually done it for itself.
O'BRIEN: OK.
GUPTA: But, basically, you have to separate the two lobes of the brain. Now, they have been fused together for 29 years. So you can imagine, like, it's almost like slowly dividing a very important piece of cheese. You cannot cut any of the cheese.
O'BRIEN: Right. Oh, there's a good -- that gives you a good angle there.
GUPTA: That's a good shot. That's right.
O'BRIEN: Now, how do you know, when you look at that, as a brain surgeon, are you able to tell which -- because -- talk about gray area, quite literally, the gray matter there. How do you know which brain cells are feeding which intellect?
GUPTA: That's an excellent question. And these two girls -- women, I should say -- make it even more interesting, because, in fact, on the right side of the brain -- I'm sorry -- the left side of the brain here, this woman over here, Ladan, actually wants to be an attorney.
The left side of the brain, which is presumably the part of the brain that's going to be the most affected, is responsible for language skills, certainly obviously important skills for an attorney. For the other twin, actually, the right side of the brain -- of her brain is going to be affected, obviously, as you can look at it just anatomically. She wants to be a journalist, the right side of the brain more responsible for creativity.
O'BRIEN: There's a bit of tragic irony in all of this.
GUPTA: There really is.
O'BRIEN: And there's a lot of those twists and turns. We're watching it very closely. When's the next update we're going to get?
(CROSSTALK)
GUPTA: I think we're going to get that within the next couple of hours. We're certainly going to keep an eye on that. Again, some of the critical phase of the operation, over this vein part that I showed you. They are working on splitting the brain now. That could take up to 10 hours to do at a stretch.
O'BRIEN: Wow.
GUPTA: Then, after that, there's going to be a lot of reconstructive aspects of this case. So it could be a couple of days still.
O'BRIEN: I know you haven't done one quite like this, but when you're operating on the brain like that -- and I know we're out of time -- but do you ever just have a moment of self-realization, that you go, I can't believe I'm doing this?
GUPTA: Well, I think the neurosurgeons I think universally feel that operating on the brain is one of the most gratifying things.
O'BRIEN: Really?
GUPTA: An operation like this, if it goes well, and these two twins do well, I think it going to be an extremely satisfying thing.
O'BRIEN: But, as you say, it's still elective.
GUPTA: It is elective.
O'BRIEN: And that has got to make it all the more...
GUPTA: It makes it more challenging in a way. This isn't life- saving. If someone dies in this case, where there's a 50/50 chase of it, it's going to be a huge loss.
O'BRIEN: Yes. The bar is a little higher than normal, isn't it?
GUPTA: That's right.
O'BRIEN: All right, Sanjay Gupta, fascinating.
(CROSSTALK)
GUPTA: Thanks.
O'BRIEN: Check in with us in a little bit, please.
GUPTA: I will, for sure.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
