Israel’s First Cranial Conjoined Twin Separation

By: Naomi Fried  |  October 21, 2021

By Naomi Fried

For the first time in Israel, Siamese twins, connected by the head, were separated successfully on September 5th, 2021. This type of surgery has only been performed about 20 times successfully worldwide.The first successful procedure separating conjoined twins was performed just 66 years ago, in 1955.

The term “Siamese twins” comes from Eng and Chang Bunker, a set of conjoined twins who were born in Siam. Due to their unique look, they were displayed in traveling exhibitions. Chang and Eng both married and fathered 21 children between them before dying at the age of 64. Approximately 70% of conjoined twins are female, and females are 3 times more likely to survive.

Connected at the head, the rarest form of conjoinment, the Siamese twins in Israel were separated at the age of one after being monitored from before they were born and under constant care of doctors until now.

The full first year of their life was spent preparing for this surgery. Preparation at Soroka Medical Center in Israel included learning what there is to know about performing such a surgery successfully; this is particularly difficult since there are very few experts in the area due to the rare occurrence of cranial conjoined twins. Additionally, the twins’ bodies  had to be prepared for the surgery. A lot of monitoring was performed as well as the growth of skin that would be used to cover the open parts of their head once separated. The technique used included placing balloons in the skulls and inflating them to stretch the skin. Innovative technologies needed to perform the surgery were found and prepared for the surgery, and the total cost of everything totaled 7 million NIS. The operating team consisted of more than 50 doctors, surgeons, anesthesiologists, pharmacists, and more.

In a briefing, Dr. Miki Gideon, the head surgeon on this case recognized and thanked many Israeli medical technology companies that helped develop material needed for the surgery.  He especially lauded  the models of the twin’s heads that were very detailed with brain and blood vessels so that they could work on these models and refer to them. These models were built based on MRI and CT scans.The surgery took more than 12 hours to complete, this is very short compared to other surgeries like this which took up to 27 hours.

Another technology used was the virtual reality (VR) simulation of the heads. With the help of remote controls, they were able to navigate on the screen. Extended reality (XR) medical visualization platform for surgical training, was used. Its 360° VR models allowed the surgeons to see all the blood vessel’s locations that would otherwise have been unknown. Although the major blood vessels could have been mapped out without this technology, the smaller yet critical vessels would have been missed, increasing the risk factor for the surgery greatly.

Dr. Miki Gideon stated that the surgery was not just successful; it was perfect.

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