Vol. X No. 7 Special Edition November, 1974 1 The Siamese twins were brought to the operating room at 5:45 a.m. and were positioned on foam rubber wedge-shaped cushions which were pulled back as the youngsters were separated. Pre-operative prepara- tions took. four hours. Clara and Alta were ready for surgery at 10: 10 a.m. Dr. Josephine Templeton (above), anesthesiologist, comforts A Jta during pre-opera tive preparations. lO%Hour Operation Combined Several Surgical Techniques Commonly Used At Children's Hospital Procedures performed on the twins that are performed several times each year at Children's Hospital Procedure Average Number Performed at Children's in a Year lmperforate Anus 8.5 The twins shared a rectum which was given to Clara at separation. However, Dr. Koop was able to build a new rectum for Alta using another muscle as a rectal sling. Omphalocele 13.5 Since the twins are joined facing each other both had a large abdominal wound after separation. By breaking the pelvic bone, pulling the hips around and suturing the pelvis together, the wound was closed in Alta. Clara had enough skin to close the wound so that no artificial skin was needed to bridge the gap in the abdominal wall. Trans Ureteroureterostomy 2 In the twins, the ureters were crossed and drained into the other ureter. They had to be resected. This technique is different from the usual implantation of ureters into the bladder and was chosen in order to avoid entering the bladder and making another opening. Two full surgical teams worked simultaneously. Twenty-three members of the 0. R. staff were needed for the separation procedure. Dr. John J. Downes, Jr., headed the anesthesiology team. Dr. John W. Duckett, Jr., headed the urology team. Orthopedic surgery was performed by Dr. Stanley Chung, Childrens chief of orthopedics. Dr. Koop was assisted by Dr. Louise Schnaufer, associate surgeon, and chief surgical residents Dr. Edwin Hatch and Dr. John M. Templeton, Jr. Actual separation took place at 12:37p.m. Though the separation of the Rodriguez twins received world-wide ac- claim, Dr. C. Everett Koop, surgeon-in- chief at Children's, notes that each proce- dure performed on Clara and Alta is performed many times a year at Chil- dren's Hospital. The separation of the twins was unique because it involved all of the procedures at once. "For example," Dr. Koop explained, "we build several rectums a year at Children's because some infants are born without a rectum. Many are born without abdominal walls. "None of the techniques used on the twins was new to us. We just had to decide the order in which we would make the repairs." Dr. Koop continued, "This is where our planning sessions were crucial. I estimate that 100 man-hours went into the planning of this operation. "We had to consider everything that could go wrong and decide how we would handle each crisis. The anesthesiology team had a tremen- dous responsibility. They were respon- sible for the life sustaining devices during surgery. Dr. John J. Downes, Jr., headed the Anesthesiology team. "I can honestly say that everything went right during the operation. The skull sessions paid off. Surgery was completed successfully at 5:lO p.m.," Dr. Koop concluded. nr Knnn .nnk~ tn the mariia after the operat -. . . .--r -~ _..I -- _.,- ..- -. "very well. `* Yen to report that the twins were doing NURSES HELP TWINS ADJUST TO SEPARATION @I TIMES Published for the staff and employees of The Children's Hospital of Philadelphia, One Children's Center, 34th & Civic Center Blvd.. Phila., Pa. 19104. Richard D. Wood Chairman, Board of Managers Charles E. Ingersoll President Warren C. Falberg Executive Vice President and Director Shirley Bonnem Director of Public Relations Susan Soiferman Assistant Director of Public Relations Mary Thomson Editor Materials used may be reprinted without permission provided appropriate credit is given to source. Clara, the larger twin, was taken off the respirator 48 hours after surgery, 24 hours before her smaller sister. When Clara woke up she was placed in her sister's crib. On seeing Alta she became very quiet, then reached out to touch Alta's hand. The youngsters remained in the same bed while at Children's Hospital. A t first nurses observed that the twins constantly sought each other out, They clung to each o the/s nightgown strings while sleeping. Before separation Clara had been the dominant twin. Because she was larger she always won the squabbles. But after surgery Alta acquired a more aggressive personality of her own. Both children were put on soft diets seven days after surgery. On the twelfth day they began to eat solid foods. Nurses reported they were eating welt and gaining weight. It wasn't long before the girls were smiling again. They learned to wave and Clara called "Bye-Bye" to everyone leaving the Intensive Care Unit.