Innovations in Surgical Planning: Optimizing Patient Outcomes for Ischiopagus-Conjoined Twins Separation

by Alice King

Coauthors: Alice King, M.D., Smriti Zaneveld, Ph.D., Prakash M. Masand, M.D., Ward Shalash, Ph.D., Sundeep Keswani, M.D., Jacques Zaneveld, Ph.D.

Medical Devices & Digital Health

In this study, we present a novel method for preoperative planning in a complex ischiopagus-conjoined twins surgery that was facilitated by a new patient-specific surgical rehearsal platform called Pre-Sure. The occurrence of conjoined twins is estimated to be around 1 in 25,000 to 1 in 80,000 births, with an average incidence of 1 in 50,000 births. Surgeons globally continue to have successful separation of conjoined twins, but every case presents unique anatomical variations and is a new challenge. The intricate anatomical structure of conjoined twins plays a crucial role in determining their chances of survival and the feasibility of separation, resulting in variations in medical approaches, surgical strategies, and, ultimately, patient outcomes. As such, a successful separation necessitates a substantial amount of preoperative planning.
The presented ischiopagus case posed a high level of complexity due to the site of connection and the shared anatomy between the twins. The planning process involved multiple surgical specialties, including pediatric surgery, urology, gastro-intestinal, orthopedic, plastic, and reconstructive surgeons. In this case the twins shared a colon and had complex genitourinary (GU) malformations, as well as requiring a complete reconstruction of the pelvic anatomy.
The inherent anatomical challenges and the variety of surgical specialties involved in this case necessitated a high degree of coordination between all providers involved. This was achieved using novel, advanced surgical planning tools, including digital 3D models, VR models, physical plastic anatomical visualization models, and a Preoperative Surgical Rehearsal (Pre-Sure) model created in synthetic materials that cut, bleed, and mimic the properties of real tissues. 3D visualization tools were used in a series of planning and simulation events to coordinate care, help the entire team understand the patient’s anatomy, and map out the steps of the procedure. Subsequently, the surgical team conducted an extensive surgical rehearsal using the life-like Pre-Sure platform to test elements of the surgical approach. The utilization of the Pre-Sure model, in conjunction with the surgical rehearsal, played a crucial role in facilitating meticulous planning and strategic execution via the hands-on approach to map out the intricate steps required for a successful separation procedure.
This report demonstrates the utility of a novel approach to preoperative planning in a unique, complex case facilitated by the Pre-Sure platform. The adoption of Pre-Sure shows promise for complex pediatric and congenital surgeries, especially those that involve multidisciplinary teams or advanced surgical techniques like robotic surgery and minimally invasive approaches. In this case, this technology and approach contributed to the positive surgical outcome for the patients and their families.