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The surgery and the preparation for it were carried out by the best and most skilled teams at the hospital, and reinforces the sense of mission that made us doctors. The next few days will be critical in the process of the twins' recovery."
The rare operation to separate the Craniopagus twins (twins conjoined at the head) was performed on September 2. The one-year-old twins were born at the hospital in August last year with their heads conjoined at the back. Dozens of staff members accompanied the family on this journey from before birth until the day of the operation. Preparations made for their complex birth included the staff of the Saban Birth and Maternity Center, physicians and nurses from the Saban Pediatric Medical Center, anesthesiologists, and imaging specialists.
The dedicated team worked for many months planning every detail. Surgery for the separation of twins conjoined at the head takes place in several stages. In the present case, in the first stage, the treatment team introduced skin and tissue expanders several months ago in order to stretch the skin to make it possible to close the scalps of the two girls after the separation.
Over the past several months, the twins underwent extensive testing. They were under continuous monitoring by the Child Development Institute at Soroka and Social Services, which supported the family members. In addition, their cardiac and respiratory functions were closely monitored. They came to Soroka for regular check-ups, and in the last three months have come for more frequent treatment to continue the skin expansion procedures and prepare for the final stage.
The multidisciplinary team used 3D models and virtual reality (VR) models to plan the surgery. The 3D models of the 3D4OP and Stratasys companies are based on MRI, CT, and angiography imaging, and simulate in the most reliable and accurate way the complexity of the connections of the twins’ blood vessels, meninges, skull bones, and skin.
The Surgical Theater company’s VR model made it possible to carry out simulations of the surgery and plan it in the most precise way possible. Using this model, it is possible to go into the depth of the connection between the twins, see shared blood vessels, and conduct simulations of all aspects of the surgery. Dozens of repetitions and simulations of all stages of the operation were performed in each of the models of all the team members.
During the operation, after the successful separation of the blood vessels, the bones were separated. At this point, the team members split into two teams that worked in parallel in two separate operating rooms, performing reconstruction of the skulls and scalps of each of the girls.
The operation, which lasted more than 12 hours, involved some 50 hospital staff members who took part in both the many preparations and the execution: specialists in neurosurgery, plastic surgery, anesthesia, pediatric intensive care, and brain imaging, operating room nurses, nursing teams, pharmacists, laboratory staff, social work service teams, and logistics teams.
The surgery and its preparations were led by:
Dr. Mickey Gideon, director of pediatric neurosurgery at Soroka and team leader; Dr. Israel Melamed, director of the Department of Neurosurgery; Dr. Yuval Sufaro, deputy director of the Department of Neurosurgery; and Dr. Ido Ben Zvi of the Department of Neurosurgery;
Prof. Eldad Zilberstein, director of the Department of Plastic Surgery at Soroka, Dr. Yaron Shoham, senior physician, the Department of Plastic Surgery;
Prof. Alex Zlotnik, chairman of the Division of Anesthesia and Intensive Care; Dr. Avner Leon, Dr. Sergei Tsaregorodtsev, Dr. Anna Grabniov, and Dr. Yotam Zhat of the Division of Anesthesia, and Mr. Shlomo Besharim, the head of anesthetic technicians team;
Prof. Ilan Shelef, director of the Imaging Institute at Soroka and Dr. Ella Bankovich and Dr. Rosa Novoa of the Imaging Institute;
Dr. Anat Horev, head of Cerebral Angiography Unit at Soroka;
Dr. Tzachi Lazar, director of the Pediatric Intensive Care Unit, Dr. Yuval Kaveri, senior physician, the Pediatric Intensive Care Unit
Tal Hayun, head nurse of the Southern Operating Room; Ricki Beiner, Nursing and Recovery Room Nursing Manager; and the Operating Room Nursing Staff: Bruria Assulin;, Ohad Schneider Mizrahi; Tal Carmel; Oksana Israelov; Vladislav Schiff; Galina Maran; Zeev Greenberg; Atwa Abu Arar; and Avishai Cohen;
Two international experts who have previous experience in surgeries of this type also took part: Mr. Noor ul Owase Jeelani, pediatric neurosurgeon at Great Ormond Street Hospital in London and the founder of Gemini Untwined, a charity set up for the treatment, research and education for Craniopagus Twins, and Dr. David Staffenberg, a plastic surgery specialist from NYU Langone in NYC.
Dr. Mickey Gideon, director of pediatric neurosurgery at Soroka: “This is a very rare operation that has been performed so far in the world only about 20 times and for the first time in Israel, in this case on one-year-old babies, among the youngest in the world on whom this surgery has been performed. The complex surgery and the preparation for it were carried out by the best and most skilled teams in the country with advanced equipment and technologies, some of which were specially brought to Soroka for the surgery, such as the equipment of the 3D and virtual reality models and special devices for monitoring oxygen saturation in the brain. This complex and unique surgery and the amazing teamwork reinforce the sense of mission that made us doctors. The next few days will be critical in the process of the girls' recovery."
Dr. Shlomi Codish, Director General of Soroka Medical Center: "As the medical center responsible for the health of the residents of the Negev, we prepared in advance for this significant and rare operation with the leading staff of the hospital together with an international team of physicians. I am very proud of our teams, of all the fields and sectors that have taken part in this challenging and complex surgery. I wish the twins and the family a full recovery."
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