 Stages of the surgery
Children's Press Release (May 10. 2006): Conjoined Twins Delivered at Washington Hospital Center Partnership with Children’s National Medical Center Provides Expert Resource for Complex Pediatric Maternal- Fetal Cases
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Tuesday, September 5
Wednesday, September 6 (Day of surgery)
Tuesday, September 5
12:00 noon
Expected duration: 3 – 5 hours
Mateo and McHale will be transported to the operating room for a number of preparatory surgical procedures, including central and arterial line placement, Foley catheter placement and final evaluation of tissue expanders in order to get the final go-ahead for surgery.
Upon completion of the procedures, the boys will be stabilized and transported back to the Newborn Intensive Care Unit (NICU) to spend the night with their parents.
Wednesday, September 6
Transport, induction and surgical preparation
6:00 a.m.
Expected duration: 2.5 hours
Mateo and McHale, accompanied by their mother and father, will be transported from the NICU by the neonatal transport team to the surgical suite. Their parents will hand them over to the anesthesiologists, where they will be taken into their operating room, intubated and given anesthesia. Significant care will be taken to position the boys to optimize access to the surgical field, and to avoid line compromise and complications due to the extended length of the surgery, such as pressure sores and tangling of lines as the surgery calls for repositioning the boys. During this time, the surgeons will make determinations for optimal placement of the incisions.
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage 6
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Stage 1
Neurological and Plastic Surgery
Expected duration: 6 – 8 hours
Initially, both boys’ neurosurgeons will simultaneously insert ventricular drains into each child’s head to address their hydrocephalus.
Next, the boys’ plastic surgeons will remove their tissue expanders. Since the duration of the surgery could potentially cause the shrinkage of some of the skin grown during the last several weeks if all of the tissue expanders are removed, the surgeons will need to assess whether it is best to remove all tissue expanders at this point, or to leave the ones on the side opposite where the surgeons will initially work. The biggest determinant will be the ability to protect the integrity of the overlying skin which will bear the boys’ weight during the initial hours of the surgery.
Next, the neurosurgery team will expose the spinal cords and nerve roots of Mateo and McHale, allowing access not only for the surgery, but for physiological monitoring. This monitoring will allow the doctors to determine literally which nerves belong to whom. This will help enable the neurosurgery team to preserve optimal neurological function for each boy during the separation of the spinal cord, particularly considering that early physiological monitoring indicated some “cross signaling” of nerves from each boy’s brain to the other’s limbs.
At this point, Mateo and McHale’s lead surgeon will begin the arduous and difficult process of separating the spinal cord. Again, great pains will be taken to preserve as much neurological function as possible for each boy.
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Stage 2
Orthopaedic Surgery: Separation of Bony Spine
Expected duration: 1 - 2 hours
The only shared bone, the sacrum (tailbone), will be gently divided using very small equipment designed specifically for orthopaedic procedures in babies. The boys’ orthopaedic surgeon will seek to divide the bone in a way that will protect their neural structures and blood supply.
Stage 3
General Surgery
Expected duration: 1 - 2 hours
This stage of the surgery involves the isolation of the boys’ organs, as well as separation of muscle, tissue and their gastro-intestinal systems. Once finished, this will complete the physical separation of Mateo and McHale.
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Stage 4
Transfer of one child
Expected duration: 1 - 1.5 hours
One boy will now be moved to an adjacent operating room. The current plan is to transfer the child via bassinet. Now, each boy will have his own team of surgeons who will perform any necessary reconstruction and close each boy’s surgical wounds.
Stage 5
General Surgery
Expected duration: 3 - 4 hours
Depending on the clinical picture, a general surgeon will perform colostomies on one or both boys.
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Stage 6
Plastic and Reconstructive Surgery
Expected duration: 2 - 3 hours
As the final step in the surgical separation of Mateo and McHale, the boys’ surgical wounds will be closed using the skin that was grown over the last several weeks.
Upon completion of the reconstructive surgery, Mateo and McHale will be stabilized by their anesthesia teams and transported back to the NICU for recovery and post-operative care.
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Conjoined Twins Delivered at Washington Hospital Center Partnership with Children’s National Medical Center Provides Expert Resource for Complex Pediatric Maternal- Fetal Cases
Washington, DC –Washington, DC, May 10, 2006- Conjoined twin boys were born this morning at Washington Hospital Center. The twins are joined at the back. The high-risk Caesarian section delivery went as planned and involved five medical teams from the Hospital Center and Children’s National Medical Center. Mom Angie Benzschawel is in good condition and twins Mateo and McHale are in critical but stable condition in Children’s Newborn Intensive Care Unit (NICU).
“After months of waiting, it was a relief for us to finally meet the boys,” said father Ryan. “We appreciate the support of everyone involved. We hope everyone will respect our request for privacy as we focus on the care of our twins.”
David Downing, MD, associate chair, Obstetrics and Gynecology at Washington Hospital Center headed the maternal and fetal medicine team. Dr. Downing praised his team for bringing mom and the twins through the challenges of this pregnancy. “We provided high-risk monitoring of mom and the fetuses on a daily basis,” said Dr. Downing “Thanks to the wonderful collaboration with Children’s and support from multiple divisions, these babies got off to a good start.”
A total of 50 medical professionals from both the Hospital Center and Children’s were involved in this morning’s delivery. A maternal/fetal team experienced in high-risk deliveries performed the C-section. In an adjoining operating room, two identical teams - each with a pediatric surgeon, neurosurgeon, neonatologist, otolaryngologist, and neonatal nurse - were assigned to each twin following delivery to attend to their immediate medical needs. An additional third team was on standby to support the other two under the supervision of Zacharia Cherian, chair, Neonatology, Washington Hospital Center. Dr. Cherian said teamwork between the Hospital Center and Children’s staff was outstanding. “This was truly a team effort and testament to the medical excellence of both institutions. We were well-planned and well-rehearsed to handle the complex medical care of these babies.”
As soon as the twins were stabilized, a fifth team - the Children’s Transport Team prepared the twins for the three-minute transport from the operating room to a waiting ambulance that whisked them to Children’s NICU. The twins will undergo a series of tests and assessments this week. Robert Keating, MD, chief, Neurosurgery, who is leading the medical care of the twins at Children’s, said, “Every member of the team continuously demonstrated poise and grace today, and no doubt made this transition nearly seamless. The delivery was one step in what will be a lengthy process. Children’s multidisciplinary team is now working to assess and monitor the most appropriate care plan for the boys.”
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Related link
Read the Washington Post's coverage of the separation
September 8, 2006
WashingtonPost.com
Listen to lead surgeon Robert Keating, MD, describe the plan for surgery
September 5, 2006
Wisconsin Radio Network
Associated Press Article "Doctors Optimistic about surgery for twins"
September 2, 2006
St. Paul Pioneer Press
Learn more about the Shaw family with WISN's coverage
August 30, 2006
TheMilwaukeeChannel.com
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