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Doctors in Critical Phase of Surgery to Separate Iranian Twins - 2003-07-07

Surgeons in Singapore have tackled the most critical phase of the world's first operation to separate adult twins joined at the head. Doctors began the surgery Sunday on 29-year-old sisters from Iran, and say they are pleased the risky procedure is going well.

The round-the-clock surgery on Laleh and Ladan Bijani continued into a second day, and a high-risk arena.

After creating a second blood vessel to carry blood away from their brains, Dr. Prem Kumar Nair said that the team of neurosurgeons separated the skull - a move that took six hours - three hours longer than expected because the bones were thick and compact.

But Dr. Nair said the delay does not worry him, because the twins are stable and the doctors do not feel pressured to adhere to a deadline. In fact, he said, now they expect the surgery to take much longer than the scheduled 48 hours, possibly as long as four days.

The 28 specialists, including experts from Singapore, the United States, France, Japan, Switzerland and Nepal, are working at an unhurried pace to the soft strains of classical music in the operating theater.

Dr. Keith Goh, the lead surgeon who also was in charge of the 97-hour operation separating Nepalese twin babies in 1991, says the doctors are holding up well. "We have such a good team of very experienced people, six neurosurgeons," said Dr. Goh. "I think we will be able to hand off to each other pretty much. And I think neurosurgeons are used to working in about six-to-eight hour rotations."

Friends of the twins have been gathering in the hospital lobby, including several who flew in from Iran. Staff at the Iranian Embassy said they spoke to the women prior to the surgery, and were asked to pray for them.

The high-risk operation could kill one of both of the women, or leave them in a vegetative state.

But the Bijani sisters, who underwent extensive psychological counseling, accepted the risk to have a chance to lead separate lives.

Previously, this type of operation has only been performed on very young twins joined at the head, because infant brains recover more easily. Twins fused at the head occur once in every two million births, the most rare of all conjoined siblings.

Ladan and Laleh arrived in Singapore last November, inspired by the success of the surgery on 10-month-old Nepalese twins, also joined at the head.