Then There Were Two
It felt like a scene from Mission: Impossible, when defusing the bomb meant cutting the right wire, says Mayo pediatric surgeon Christopher Moir, recalling a high-drama moment in the OR last May. Moir was staring at two identical vessels in the liver shared by conjoined babies Abbigail and Isabelle Carlsen and needed to decide which to cut first in his quest to divide their fused organ and separate the 5-month-olds. "One was the liver's major blood vessel. If we cut the blood vessel first, the whole liver would go. The difference was life or death. It got very quiet in the room."
Moir, however, had a big advantage: Though no one had seen a liver like the girls' before, he had already taken a virtual tour. Imaging specialists had scanned in great detail the babies' entwined intestines, their hearts-one tipped into the other twin's chest-and that singular shared liver. Using a combination of CT, MRI, and powerful computer programs, they had created three-dimensional models of every aspect of the strange anatomy, allowing Moir and his team to plan the operation in advance.
In particular, the images revealed the organ's lookalike bile duct and portal vein, which crossed over one another in a very unusual pattern. According to the scans, the bile duct was the lower of the two. Hoping the scans were accurate, doctors cut the lower tube. "When I saw the bile come out, I knew it was going to be a success," Moir says. It took 10 more hours to separate the twins, who, according to their father, are thriving toddlers today. "But in my mind at that moment," Moir says, "the confetti was already flying."
This story appears in the April 16, 2007 print edition of U.S. News & World Report.
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