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Teamwork, planning key to separating conjoined twins

By Carole Bartoo and Laurie Holloway
July 2009

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Three-month-old conjoined twins Keylee Ann and Zoey Marie Miller were separated in a complex operation on April 7 at the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

The surgery was the first of its kind at Vanderbilt and is believed to be the first successful separation of conjoined twins in Tennessee. It was carefully planned and carried out by a team of 30 medical, surgical and nursing personnel.

“It was pretty exciting to finally get them separated,” said Wallace (Skip) Neblett, M.D., lead surgeon. “We talked about this and planned it for months as the babies matured.”

The girls were born Jan. 4 in Johnson City, Tenn., and were immediately transferred via LifeFlight to Vanderbilt’s Neonatal Intensive Care Unit (NICU). Together, they weighed 4 pounds, 12 ounces. The twins were cared for in the NICU for three months until they grew strong enough for the separation surgery.

By the day of the separation surgery, the twins weighed a combined 7 pounds, 10 ounces and were in good health.

James O’Neill, M.D., professor of Surgery, Emeritus, took part in the separation of Keylee and Zoey, and has participated in the surgical separations of 23 sets of conjoined twins elsewhere, more than any other physician in the country. He planned and led three drills in the weeks leading up to surgery.

“We wanted this to go smoothly, so we practiced to make sure we had all the essentials ready for potential complications,” said O’Neill.

The preparation alone, which involved starting IVs and keeping equipment cords and drapes out of the path of the constantly moving team members, took four hours. The first incision was made at 11:25 a.m. The babies were separated for closure procedures just 90 minutes later, at 12:52 p.m.

Their recovery has been uncomplicated and the family has taken them home.

View a slideshow at www.vanderbiltchildrens.org

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