SINGAPORE - More than 34 hours into their marathon operation to separate conjoined Iranian twins, surgeons had successfully split a critical shared vein but were being slowed in detaching their brains because the tissues were tightly fused together.
A spokesman at Raffles Hospital said the brains of Ladan and Laleh Bijani, though distinct, are "very adherent" because they have been attached for the past 29 years.
"They have to be teased apart very slowly. Cut, teased apart, cut, teased apart," Dr. Prem Kumar Nair said at a briefing in the hospital lobby. "That's taking a long time."
The separation of the brains was originally expected to take from eight to 10 hours. But Nair said the work - which is being done millimeter by millimeter - would probably take much longer.
"It's still in the very early stages," he said.
In addition to being slowed in the separation phase, doctors have found that the blood circulation between the twins is unstable, causing the pressures in their brains and circulatory systems to fluctuate. The surgeons have not had to stop their work, Nair said, but the team has made adjustments accordingly. "The process will continue as we have been doing for the last few hours," he said. "We hope that in the process everything comes out fine."
Despite the difficulties, doctors have achieved a major medical triumph: dealing successfully with a shared vein at the backs of the twins' heads that serves as the main drainage system of the brain.
German doctors said in 1996 that the surgery to detach the twins would be too risky because of the shared sagittal sinus. But, working for more than 12 hours, vascular surgeons created a new sinus for Ladan using a vein taken from her right thigh at the start of the operation. Until yesterday, the medical team had not known which sister would get the existing vein, which is much larger than usual, and which one would get the graft.
Even though she got the bypass, Ladan is said to have the same chance of surviving the high-risk surgery as her sister.
Nair said the neurosurgeons, including Dr. Benjamin S. Carson of the Johns Hopkins Children's Center, were taking breaks as needed, though they remained close to the operating room at all times. Earlier yesterday, he described the atmosphere in the operating room as calm.
"Everything is quite calm, measured, lots of discussion going on. I think that's the way we hoped it would happen," he said.
Appearing in the lobby before several dozen members of the media and a few of the twins' close friends, the Iranian ambassador to Indonesia, Shaban Shahidi-Mo'addab, made an unexpected announcement: that the Iranian government would fully cover the twins' postoperative expenses, expected to total about $300,000. A fund that had been set up by Raffles Hospital to raise the money reportedly had not brought in even a quarter of that amount.
The ambassador also read a letter from the president of Iran, Mohammad Khatami, thanking the international team of doctors and expressing hope for a good outcome. He held up two framed copies, one each for Ladan and Laleh.
Hospital officials did not estimate last night how much longer they expected the operation would take. Doctors have said from the start that it would last at least 48 hours, though they fell several hours behind during the first day.
"I think there's still a long way to go if you look at the entire operation," said Nair.