Three-month-old conjoined twins Keylee Ann and Zoey Marie Miller were separated April 7 during a complex eight-hour operation at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. The surgery, carried out by a team of 30 medical, surgical and nursing personnel, was the first of its kind at Vanderbilt and is believed to be the first successful separation of conjoined twins in Tennessee.
“It was pretty exciting to finally get them separated,” says Dr. Wallace (Skip) Neblett, lead surgeon. “We talked about this and planned it for months as the babies matured.”
In the United States the incidence for conjoined twins—identical twins who develop from the same fertilized egg—is one per 200,000 live births. The girls were “omphalopagus” twins, fused from the lower breastbone to the navel. They shared a liver and part of a diaphragm, and were born with one umbilical cord.
Born Jan. 4 in Johnson City, Tenn., the girls were immediately transferred via LifeFlight to the Neonatal Intensive Care Unit (NICU) at Vanderbilt’s Children’s Hospital. Together they weighed 4 pounds, 12 ounces. Their parents, Victoria Ford and her husband, Brian Miller, knew early in the pregnancy that the twins were conjoined. In January, when Zoey and Keylee were in fetal distress, the girls were born by Caesarean section 10 weeks early.
The twins were cared for in Vanderbilt’s NICU until they grew strong enough for the separation surgery. On March 24, Zoey required surgery for a heart defect. That operation required that Keylee go under general anesthesia as well. Staff and faculty in the NICU devised systems to administer medications Zoey needed to recover from her heart surgery without causing harm to Keylee. The twins shared a common circulatory system.
In the weeks leading up to the separation, Dr. James O’Neill, professor of surgery, emeritus, who has participated in the surgical separations of 23 sets of conjoined twins—more than any other physician in the country—planned and led three drills. “We wanted this to go smoothly, so we practiced to make sure we had all the essentials ready for potential complications,” O’Neill says. “We were absolutely prepared.”
Because there were two patients, two full surgical teams had to be present in the operating room. Both girls possessed all the essential blood vessels and connectors, so each had her own completely functional liver without the need for complex repair. Their recovery has been uncomplicated, although Zoey must return at a later date for another heart surgery.
View a slide show of the separation surgery at http://snipurl.com/vutwins.
