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Carter and Conner, conjoined twin boys born Dec. 12, 2014, in Jacksonville, Fla., underwent a successful separation surgery on May 7, 2015. The 12-hour surgery began at 7:11 a.m., led by a team of highly skilled pediatric specialists that included Daniel Robie, MD, chief of pediatric general surgery, and Nicholas Poulos, MD, pediatric general surgeon, for Nemours Children’s Specialty Care and Wolfson Children’s Hospital. The boys were separated at 3:34 p.m.
Conner’s surgery was finished at 6:29 p.m. and he was transferred from OR 8 to the Pediatric Intensive Care Unit (PICU) at Wolfson Children’s Hospital at 6:52 pm. Carter’s surgery ended at 6:47 p.m. and he was transferred to the PICU at 7:14 p.m. to join his brother.
The separation involved a 17-member surgical care team (blue for Carter, green for Conner and white for surgical support), including Stephen Dunn, MD, Division Chief of Solid Organ Transplant, for Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., who travelled to Jacksonville to assist the team in separating Conner and Carter’s fused livers.
Preparing for the Separation
Leading up to the surgery, the twins’ integrated care team spent months preparing for the complexities of this separation, including MRI studies, a medical illustration of the conjoined areas, clinical and logistical simulations of the final separation surgery and specific procedures, and keeping the boys as healthy and strong as possible considering their multiple medical challenges.
From the day after their birth to the morning of their final separation surgery, Carter and Conner received care in Wolfson Children’s Hospital’s Level III Newborn Intensive Care Unit (NICU) under the direction of Josef Cortez, MD, and Ma Ingyinn, MD, neonatologists with the University of Florida (UF) College of Medicine – Jacksonville.
During their stay to now, the boys have been cared for by nearly 200 health care professionals that include neonatal and pediatric critical care nurses, pediatric respiratory therapists, rehabilitation therapists, Child Life specialists, pediatric chaplains and other health care disciplines.
Before Separation Surgery
On Dec. 13, 2014, the twins underwent emergency surgery to repair a potentially life-threatening condition called a ruptured omphalocele, in which their shared small intestine protruded through a weak area of the abdominal wall. Dr. Robie and Dr. Poulos positioned the babies’ shared small intestine back inside their abdominal wall and placed a temporary mesh patch over it to keep the bowel inside.
On Jan. 2, 2015, the boys underwent an additional surgery to remove the temporary mesh. Dr. Robie and Dr. Poulos then partially separated the shared small intestine to enable the babies to feed orally. During the procedure, the pediatric surgeons discovered that the boys had two bile ducts that also were fused. Conner and Carter’s livers and bile ducts were left intact for the May 7, 2015, separation surgery.
After Separation Surgery
Solange Benjamin, MD, medical director of the PICU, is leading a multidisciplinary team of UF College of Medicine – Jacksonville pediatric critical care physicians and Wolfson Children’s Hospital pediatric critical care nurses, respiratory therapists and many other health care professionals during what is likely to be a sustained recovery.
“The 24 to 48 hours following surgery were crucial, but the boys are being ably cared for by our PICU team,” said Dr. Benjamin. “The twins are still critical but stable at this time, which is expected.”
She added, “Our ultimate goal is to prepare Carter and Conner for their lives as healthy and active boys.”
From Birth to Separation
Carter and Conner were born on Friday, Dec. 12, 2014, to Michelle Brantley and fiancé Bryan Mirabal at UF Health Jacksonville at 11:14 pm. Although Michelle’s planned Caesarean section delivery was scheduled for Wednesday, Dec. 17, she went into labor and gave birth at 36 weeks. Father Bryan said that the identical and conjoined twins were born weighing a total of 10 lb., 2 oz.; Carter was 19” long and Conner was 18” long. Conjoined twins are extremely rare, with estimates ranging from one in every 100,000 births to one in every 200,000 births.
Hope for the Future
“We are honored and thank the Mirabal and Brantley family for placing their trust in us to care for their beautiful baby boys,” said Dr. Robie. “During this critical period on the road to recovery that is ahead of Carter and Conner, they have the wonderful support of their family and a skilled care team who are committed to their recovery, development and best possible health.”
Carter and Conner’s mother, Michelle, said, “We are so grateful to everyone who has taken care of our babies. We had so much confidence in them and they have been so good to us and to our family. We can’t wait to take Carter and Conner home!”