February 2016: Conjoined Twins Separation Surgery

Overview of Conjoined Twinning

Conjoined twins occur once in every 200,000 live births, the University of Maryland Medical Center estimates.

The cause of conjoined twinning remains uncertain, but the Seattle Children’s Hospital presents two common theories: either a single egg is produced but does not fully separate after fertilization, or the egg divides entirely but then reconnects.

According to the University of Maryland Medical Center, between 40 and 60 percent of conjoined twins are stillborn, only 35 percent survive their first day, and the overall survival rate ranges from 5 to 25 percent. Conjoined twins are always the same sex, as they are genetically identical. More male twins conjoin than female, but females are about three times as likely to be born alive.

 Conjoined twins connections vary from a small amount of shared tissue to more complex unions of vital organs like a heart or brain, parts of digestive, genital and urinary systems, or an entire segment of the body like the legs or skull. There are several classifications of conjoined twins defined by the site of attachment.  According to Medscape, 74 percent of conjoined twins are joined at the chest, abdomen, or both, and referred to as Thoracoomphalopagus twins. They are followed by 18 percent joined at the buttocks (Pygopagus), 6 percent joined at the ischuum (Ischiopagus), and 2 percent joined at the head (Craniopagus). Because no two sets of conjoined twins are alike, the surgical process is always unique.

 Worldwide, only about 250 separation surgeries have been successful, meaning at least one twin survived over the long term, according to the American Pediatric Surgical Association. The surgical separation success rate has improved over the years, and about 75 percent of surgical separations result in at least one twin surviving. Click here for CNN’s list of newsworthy cases of conjoined twins.

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Conjoined Twins who Shared a Skull are Separated in 10-hour Operation
This month, conjoined twin sisters Tuga and Yakeen underwent their fourth surgery resulting in their separation. The 10-hour surgery includes a team of 22 doctors and nurses at the Specialist Children’s Hospital in Riyadh, the capital of Saudi Arabia.  Read

3D Printing Helps Separate Three-month-old Conjoined Twins in China
A team of Chinese doctors from the Children’s Hospital of Fudan University in Shanghai has used 3D medical technology to help plan and execute life-saving surgery on a pair of three-month-old conjoined twin brothers. A five-hour operation that took place in January 2016 represents the first time a Chinese hospital has used both 3D modeling and 3D printing technology to successfully separate conjoined twins.  Read more…

CT Imaging and 3-D Printing Aid Surgical Separation of Conjoined Twins
“It was one of the most complex separations ever for conjoined twins,” said the study’s lead author, Rajesh Krishnamurthy, M.D., chief of radiology research and cardiac imaging at Texas Children’s Hospital. A combination of detailed CT imaging and 3-D printing technology was used in the surgical planning for separation of conjoined twins, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA) in December 2015.  Read more…

Rare Identical Triplets, Two Conjoined, Born in Texas
A rare set of identical female triplets, including two conjoined at the pelvis, were born in May 2015 at a south Texas hospital.The three baby girls were delivered Saturday by C-Section one day shy of 34 weeks. All weighed 4 pounds, 11 ounces and were currently breathing without the assistance of a respirator, the hospital said.  Read more…

Perioperative Puzzle: Conjoined Twin Separation Surgery CrosswordTest your knowledge of conjoined twin anatomy and surgery with this month’s crossword puzzle.When you’re ready to check your answers, follow this link to see how well you did. Good luck!

Apps

Touch Surgery, developed by Kinosis. Touch Surgery is a surgical simulator that guides you step-by-step through a wide variety of surgeries in different specialties. New 2016 version just released. Compatible with iPhone, iPad, and iPod Touch.

Click here for in-depth information about the app and links to buy it in the App Store or at Google Play.

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Jobs
Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours

Monday-Friday 8:00am – 4:00pm

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Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

ACS Surgery News: Specialty News and Commentaries, Videos and More
AORN Legislative Map: What’s Happening in My State
RNFA Scope of Practice by State (PDF)
ACS List of Cases that Require an Assistant at Surgery (PDF)
AORN Perioperative Bookstore
Perioperative Nurse Links (state nursing boards & professional associations

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