The surgical maestros who separated once-conjoined twins Krishna and Trishna gathered today for the first time since the operation to reflect on the incredible series of events.
Neurosurgeons Wirginia Maixner and Alison Wray; plastic surgeons Andrew Greensmith, Tony Holmes and David Chong; anaesthetists Ian McKenzie and Andrew Davidson; anaesthetic technologist Jenny Fuller; and neurology associate nurse unit manager Marie Devlin, were applauded by colleagues, media and staff from Moira Kelly’s Children First Foundation in the hospital’s lecture theatre.
Dr Wirginia Maixner, who led the team throughout the 32-hour operation, could not contain her pride.
“I don’t think you can possibly imagine how proud I am to work with such an extraordinary team. You think it’s a one-man show, but it could never possibly be.
“It’s a real credit to this hospital and Victoria in general that we’ve done what we’ve been able to do,” Dr Maixner said.
The operation began at the back of Trishna and Krishna’s heads. Plastic surgeons removed the skull and re-closed the skin around the brain before turning the girls over. Neurosurgeons Dr Maixner and Dr Wray were then able to begin their job of delicately disconnecting brain tissue and vessels.
Rest was an ongoing theme for both the patients and the medical staff. Dr Maixner said there were occasions when they stopped to rest the girls’ brains during blood pressure changes or when the state of the brains changed.
She said she and Dr Wray also stopped to rest when they felt it necessary. But Dr Maixner added that concentrating for extended periods of time is simply what surgeons do. “The skill and training we have is to stay focused,” she said.
While Dr Maixner admitted the surgery was longer than any other she’d been involved in, she said the effort and pressure paid off when the female neurosurgical tag-team made the final disconnection.
“I looked at Alison, Alison looked at me, and I said: ‘I think we’ve done it’,” Dr Maixner said.
According to Dr Andrew Greensmith, careful planning and a team approach were pivotal to the team’s success. “We used high tech, expensive models made and donated to us from overseas to simulate the girls’ skulls and brains.”
The team also used custom-made foam wedges to support the girls when they were moved into different positions. “It involved thinking outside the square,” Dr Greensmith said.
His colleague Dr Tony Holmes echoed Dr Greensmith’s sentiment. “We had a plan A, B, C and D.” He said separating the twins left such a large gap in their skulls that simply laying skin over the gap would not deal with atmospheric pressure changes.
“Quite often other operations around the world came unstuck at this point,” he said.
Plan A was to use synthetic plates that could be manipulated on the table to cover the brains.
“We even had a back-up team of microsurgeons to use muscle to close the gap, but luckily plan A worked,” Dr Holmes said with delight.
After surgery the girls were wheeled into the Paediatric Intensive Care Unit to recover at a gentle pace. Trishna was slowly weaned off anaesthetic and allowed to wake overnight. She is now talking a little and “being Trishna”, according to Dr Maixner.
Krishna will be woken up more slowly. The aim is to allow her body and brain to adjust to a different circulation.
Dr Maixner said she drew a breath of relief when she saw the twins’ first brain scans. “We haven’t caused any injury to the brain. The brains look really good, really good,” she said. “I think I did the chicken dance!”
Dr Maixner originally gave 50-50 odds of the girls sustaining some form of brain damage.
Also promising is that the girls are showing no signs of infection at this point.
Of course the journey is far from over for Krishna and Trishna. They will need to adjust to not having another child next to them. But so far, the team could not be happier with their progress.
Dr Maixner said she’s reminded everyday of what they were working towards.
“When you go into ICU and see two girls lying in separate beds, you go ‘Wow! That’s pretty amazing’.”
Dr Holmes, too, is ecstatic. “It’s a jewel in the crown for Victoria and Australia. Nothing could have exemplified team spirit more than this procedure,” he said.