Lakshmi Tatma - Surgery

Surgery

Before the operation, while being treated for the ulcer and the fever, she was again sometimes an object of worship as an incarnation of the goddess Lakshmi. She could drag herself around, although impeded by the trailing parasitic twin.

She was the subject of a surgery carried out by Dr. Sharan Patil and 30 other physicians which included Chief Anesthetist Dr. Yohannan John at Sparsh Hospital in Bangalore, Karnataka.

The twins' two pelvises formed a single combined ring. Each twin had one working kidney. Lakshmi had a second kidney which was necrotic. The autosite's feet were affected by clubfoot.

Her abdominal aorta gave off iliac branches to the autosite's legs and continued as a main trunk artery which gave off iliac branches to the parasite's legs and continued, and finally forked into the parasite's subclavian arteries.

The parasitic twin's spine and abdomen merged with Lakshmi's body. The twins' backbones were joined end-to-end and nerves were entangled. Lakshmi could not crawl normally or walk, but she could drag herself around somewhat. Doctors surmised early on that without the operation, she would not be able to live into her teens. The surgery began on Tuesday, 6 November 2007, at 7 am IST (1:30 AM UTC), and was planned to last 40 hours at the most. An estimated cost of over USD$625,000 was paid entirely by the hospital's charitable wing Sparsh Foundation. A team of more than 30 surgeons worked in shifts. The surgery lasted for 27 hours. The doctors gave Lakshmi a 75-80% chance of survival during the surgery.

The steps of the operation were:

1. (8 hours): Abdominal operation: remove the parasite's abdominal organs.
2. Remove the autosite's necrotic kidney and replace it with the parasite's kidney. Tie off the blood vessels that supplied the parasite.
3. Move the reproductive system and the urinary bladder into the autosite.
4. (6 to 8 hours) Amputate the parasite's legs at the hip joints: this caused heavy bleeding. Cut the joined backbone: the nerves around the joint were found to be extremely chaotic, and care had to be taken to avoid causing paralysis.
5. Separation, at 12.30 am on 7 November 2007. The combined pelvic ring was divided through or near the parasite's hip joints and not at the pubic symphyses. The remaining incomplete pelvic ring was cut and bent to make the ends meet, and not left as an open part-circle.
6. External fixation to hold the parts of the pelvis in place. This caused the pelvis to close in 3 weeks to the normal position.
7. (4 hours): Suturing. Operation completed at 10 am on 7 November 2007.

After the operation, the camera showed the amputated parasite and its legs laid out so that for a while they looked like a separate human form.

Lakshmi's recovery so far has been swift and satisfactory. Within a week after the surgery, the doctors held a press conference showing Lakshmi being carried by her father. Her feet were still bandaged. She was in the hospital for a month after the operation.

Afterwards, she and her family moved to Sucheta Kriplani Shiksha Niketan in Jodhpur in Rajasthan, where Lakshmi joined a school for disabled children and her father got a job on that school's farm.

As of February 2008, a later operation is planned to bring her legs closer together. Another operation may be needed to rebuild pelvic floor muscles.

The last view of her in the first television program showed her making an effort to walk, with her thighs fastened together with a spacer to keep her pelvic ring in place while it heals, and casts on her shins and legs.

The second television program showed her recovering well. It was found that cutting the conjoined vertebral column in the separation operation did not cause paralysis. She was operated on for clubfoot. X-ray showed that extra bone between the pubic symphysis (parts of the parasitic twin's ischium and pubis bones) had been absorbed, or were not ossified. Slight scoliosis was found, but was correctable by a minor operation; her mother was unwilling for her to have to wear a spinal brace through all childhood.