Complex Twin Surgeries: A Fetal Medicine Expert’s Perspective

Verified by Dr Priya Deshpande- Senior Consultant Fetal Medicine at Apollo Hospitals Navi Mumbai

When a fetal medicine expert encounters the possibility of conjoined twins, a critical question arises: Is this a chance to push the boundaries of modern medicine, or is it an overwhelming challenge? As a specialist in fetal medicine, the responsibility to guide and support parents through the complexities of these rare cases is profound. Conjoined twin surgeries are among the most intricate and demanding procedures, requiring not only medical expertise but also compassion and careful decision-making.

Understanding the Challenges

Conjoined twins develop when an embryo only partially splits to form two individuals. As a result, the twins may share anything from superficial tissues to vital organs, making each case unique and highly complex. The likelihood of conjoined twins is extremely rare, occurring in about 1 in 200,000 live births. For a fetal medicine doctor, the first step is diagnosing this condition early, usually through detailed ultrasound examinations and, in some cases, MRI scans.

Early diagnosis is crucial because it allows for thorough planning and counseling. As the pregnancy progresses, the doctor must monitor the health of both twins closely, understanding the specific anatomy and the extent of their connection. This information is vital for developing a plan for possible separation surgery after birth.

Preparing for Surgery

If surgery is a possibility, the preparation begins long before the twins are born. As a fetal medicine doctor, coordinating with a multidisciplinary team is essential. This team includes pediatric surgeons, anesthesiologists, radiologists, and sometimes even ethicists and psychologists. The goal is to gather all necessary information to make informed decisions about the surgery.

The surgery itself is complex and typically requires multiple stages. The first stage might involve separating less critical shared tissues, such as skin and muscles. As the surgery progresses, the team must carefully navigate through shared organs, blood vessels, and nerves. This stage is the most challenging and carries the highest risks.

In some cases, innovative techniques like tissue expanders are used to grow extra skin before surgery, helping to cover exposed areas afterward. Virtual reality simulations can also be valuable, allowing the surgical team to rehearse the procedure before performing it on the twins.

Reflecting on Outcomes

The outcomes of complex twin surgeries can be highly variable. Some surgeries result in both twins surviving and eventually leading healthy, independent lives. These successes are a testament to the advancements in medical science and the dedication of the healthcare teams involved.

However, not all surgeries have positive outcomes. The risks are significant, and some twins do not survive the procedure. Even in these difficult cases, the experience contributes to a growing body of knowledge that can improve the chances of success in future surgeries.

Conclusion

From a fetal medicine expert’s perspective, complex twin surgeries are a delicate balance between medical expertise, ethical considerations, and emotional support. These surgeries represent some of the most challenging and rewarding aspects of modern medicine. With advancements in technology and surgical techniques, there is hope for more successful outcomes in the future, offering a brighter future for families facing the uncertainty of conjoined twin pregnancies.

Connect with our expert, Dr Priya Deshpande- Senior Consultant Fetal Medicine at Apollo Hospitals Navi Mumbai

Call 022 6280 6280 for an appointment