- The Washington Times - Friday, July 11, 2003

BALTIMORE — A renowned neurosurgeon who assisted in the failed attempt to separate adult conjoined twins said yesterday the operation should have been done in stages over a few weeks instead of one procedure.

Performing the surgery all at once felt like “heading into a dark jungle to hunt a hungry tiger with no gun,” said Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children’s Center, who took part in the international effort to separate Laleh and Ladan Bijani.

The 29-year-old Iranians died within 90 minutes of each other this week because of blood loss during surgery.

Dr. Carson has led surgical separations of three sets of conjoined twins, all of whom were younger than 1. The operation on the Bijani twins, however, was fraught with difficulties not seen in infants.

Dr. Carson said much was learned to improve the chances of successfully performing such an operation in the future.

“If I had to do it again tomorrow from the things that have been learned already, I think the chances would be much greater of succeeding,” Dr. Carson said.

Dr. Carson said observations in the operating room convinced him that the procedure should not be done in one operation.

“First of all, I would only embark upon a situation like this again if beforehand there was an understanding that we were going to do it in stages,” Dr. Carson said at a news conference yesterday at Johns Hopkins Hospital.

Dr. Carson said he would prefer three or four stages that would take place over a few weeks. “I think it would have made a big difference.”

Dr. Carson also said he would not have positioned the twins in a sitting position. The twins were seated to make them both easily accessible to doctors struggling to complete the separation in one stage.

“I would have them lying down and I would separate the bone on one side and then turn them over and separate the bone on the other side,” he said.

The neurosurgeon said he also would have concentrated more on separating the brain tissue, which had become fused over the years.

Dr. Carson said he plans to write about the operation, which will be discussed at a medical conference in San Diego in September.

Dr. Carson predicted “there will come a day when twins such as these can have a normal life and a safe separation” and that “Ladan and Laleh will have contributed very significantly” to that.

The twins had been given about a 50 percent chance of survival.

Surgeons repeatedly encountered surprises that preoperative scans and tests didn’t reveal. The skull bone was denser and harder to cut than expected, the twins’ distinct brains had fused with tissue and their blood pressures and brain pressures proved unstable.

In the end, it was the unpredictable changes in how their blood flowed, and surgeons’ inability to cope with those changes, that killed the sisters.

Doctors consulted with the family about considering a new plan, including a second-stage surgery, but the family was adamant about moving forward so the doctors proceeded, Dr. Carson said.

Over three days, the team of 28 doctors and about 100 medical assistants worked in tight spaces surrounding the twins, who were in a custom-built brace connected to IVs and monitors.

The women were aware of the operation’s high risks but had pressed for the surgery with the hope of living independent lives.

Dr. Carson described them as “amazingly cheerful and optimistic.”

“They both grabbed my hand and held on to it, and they knew that they would either come out separated or that they probably wouldn’t suffer … and that made them happy,” he said.

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