AN ASTOUNDING video shows a ‘marathon’ 24-hour operation to separate conjoined twin girls born fused together at the skull.
Abigail and Micaela Bachinskiy were just nine months old when they underwent the painstaking procedure that needed more than 30 medics to carry out.
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Connected at the head from the moment they were born, the little girls were fully separated during a 24-hour long surgery on October 24, 2020, and were able to look at each other for the first time.
Their care team spent countless hours planning out the logistics of the “marathon” procedure, mapping out nerves and blood vessels, practising with conjoined manikin dolls and rehearsing in the operating room custom-built for the procedure.
Thirty surgeons, nurses, anaesthesiologists and other key surgical staff crowded in the operating room to help separate Abigail and Micaela, while their parents waited anxiously outside.
“This is the best present of my life, it’s very exciting, it’s a huge blessing,” mum Liliya Miroshnik said.
The twins’ mum Liliya first learnt that she was pregnant with conjoined twins when she was 11 weeks along.
Initially told she would have to terminate her pregnancy, her doctor referred her to the UC Davis Fetal Care and Treatment Center, who cared for Liliya and the twins for that point on.
Abigail and Micaela were born in December 2019, and spent seven weeks in the noenatal intensive care unit (NICU) before going home.
They were born connected at the head, a condition called craniopagus twins.
While conjoined twins are already extremely rare, craniopagus twins are even more so – with only two per cent of conjoined twins born fused at the head.
Craniopagus twins occur in approximately one in every 2.5 million births, according to UC Davis.
METICULOUS PLANNING
Surgeons decided to separate the conjoined twins when they were nine months old, as the procedure would get riskier the longer they waited.
Lead plastic surgeon Granger Wong explained: “As they get older, there are more risks of shared blood vessels and organs becoming larger or more entwined.”
To prepare for the surgery, the surgical team spent months carefully tracking the twins’ growth through MRIs and CT scans.
In the months before the procedure, Dr Wong’s team placed custom-designed tissue expanders underneath the skin of the girls’ heads to encourage more skin to grow and ensure there would be enough to cover their exposed heads after separation.
They also made multiple models of the twins’ fused skulls with 3D printing and used mixed reality goggles to familiarise themselves with the complex network of blood vessels they needed to detangle and separate.
UC Davis documented the lead-up to the surgery and marathon procedure in a six-part video series.
‘A CHOREOGRAPHED BALLET’
Rehearsals became reality for the UC Davis surgical team as they crowded into the custom-built operating room on October 24, 2020.
With a photo of the twins, their parents Liliya and Anatoliy and their three older brothers watching over them, members of the surgical team donned different coloured caps to delineate their roles on the day.
Lead surgeons wore black caps, those taking care of Micaela wore purple caps while those caring for Abigail wore orange.
Surgical residents wore grey caps and could assist with either girl.
Even equipment was labelled with purple and orange masking tape for teams to know what to reach for.
“Everyone knew where they needed to go and it was seamless,” clinical nurse Aida Benitez said.
Despite careful planning, there were still elements that the team weren’t sure about going into the surgery.
UC Davis Director of Paediatric Anaesthesiology Dr Raj Dhamrait, said surgeons knew the twins were “connected somehow”.
“But we really didn’t understand how one would affect the other.”
Other remarkable stories of conjoined twins
ONE incredible example of conjoined twins were George and Lori Schappell, who defied expectations by living to the age of 62.
Doctors had predicted the twins, who were fused at the head, wouldn’t live past their 30s.
Born on September 18, 1961, in Pennsylvania, they had partially fused skulls and shared vital blood vessels as well as 30 per cent of their brain, Guinness World Records reported.
Despite being joined to each other, the pair lived as independently as possible.
George went along with Lori as she worked in a hospital laundry.
Throughout the nineties, George had a successful music career in the States and won an LA Music Award for Best New Country Artist.
Lori and George passed away on April 7, 2024, at the University of Pennsylvania Hospital.
They surpassed the record of Masha and Dasha Krivoshlyapova, who passed away at the age of 53 in 2003.
What does it mean to be a conjoined twin?
Conjoined twins are twins born with their bodies physically connected.
They develop after an early embryo only partially separates to create two individual fetuses.
Their condition is usually discovered early in pregnancy with a prenatal ultrasound.
Conjoined twins occur once in every 50,000 to 60,000 births, according to the Children’s Hospital of Philadelphia.
About 70 percent of conjoined twins are female, and most are stillborn.
Most are connected at the chest and abdomen – but others can be connected at the head, hips, pelvis, legs, or genitalia.
Conjoined twins often share one or more of their internal organs, which impacts survival rates and the success of separation surgery.
Twins with separate sets of organs are more likely to survive than those who share them.
The twins had to be turned over five times during the surgery, a precarious move that needed multiple pairs of hands.
Four hours in, Dr Wong removed the tissue expander from the girls’ skulls.
The neurosurgery team stepped in after that to divide the twins’ brains and veins, so they could have independent circulatory systems.
The team performed a challenging fistula ligation, a process that involved clipping and separating large shared veins.
Liliya was outside the whole time, waiting and praying for good news with the support of her family and friends, while Anatoliy stayed home with the boys.
The twins’ underwent a blood transfusion and 20 hours into the procedure, their skulls were separated.
Almost exactly 24 hours after entering the operating room in one bed, Abigail and Micaela were wheeled out in two.
Liliya was rendered speechless at the news that her two little girls had been separated and made it through the surgery.
Aida recalled how “the sun was starting to peak over the buildings” as they wheeled the girls out of the operating room.
“To me they just looked like angels. The sun hit their foreheads and I realised this is the hand-off, our job here is done.”
MISSED MILESTONES
Liliya was finally able to pick up each of her little girls separately.
“I wanted to hug and kiss every doctor, every nurse,” the mum said.
She was flooded with “relief, happiness, love, appreciation” for all the members involved in the painstaking process.
At 10 months old, the twins were finally able to complete milestones they’d missed so far – like sitting up and crawling.
And they were able to make eye contact with each other for the first time.
Abigail and Miceala still needed a number of procedures, but they are bonded for life despite not being physically connected any longer.
In a recent Instagram post, Liliya shared that the “love between [them] is very special”.
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