At about 6 p.m. on Dec. 6, two-year-old Eva Sandoval was wheeled across the hall from her twin sister, Erika, the first time in the girls' lives that they had ever been in different rooms. The formerly conjoined twins had just been successfully separated at Lucile Packard Children's Hospital Stanford, and Eva was being moved to another operating room in preparation for both girls' reconstructive surgeries.
Since early yesterday morning, Erika and Eva have been in the same room again, recovering from their 17-hour separation surgery in adjacent -- but separate -- beds in the hospital's Pediatric Intensive Care Unit. They're expected to spend about two weeks in the PICU, the first step in the recovery that will eventually see them returning home with parents Arturo and Aida Sandoval to Antelope, California.
The Sandovals were supported at the hospital on Tuesday by many family members and friends, who kept the family company, prayed with them, and cheered each phase of news about the twins' separation as it progressed. Inside the operating rooms was an even bigger group: the team of 50 surgeons, anesthesiologists, nurses and other support staff who worked diligently on the separation, led by pediatric surgeon Gary Hartman, MD. From the hospital's story about the procedure:
Erika and Eva had received comprehensive CT and MRI scans as part of the preparation for surgery, and these were used to print 3-D models of their pelvic bones and blood vessels to help plan the division. But there were still questions about details of the girls’ shared anatomy, which the team spent about an hour resolving at the beginning of the surgery.
'We had amazing information from our radiology colleagues, but even with that there were some surprises,' Hartman said. 'There was only one large intestine. It appeared that it all belonged to Eva but had some blood supply from Erika, so we had to do some testing in the operating room to clarify that.' During surgery, the team also found that the girls shared a single pericardial sac around their separate hearts, and that each child had her own gallbladder.
Once the exploratory phase was complete, the team divided the twins’ liver and split their gastrointestinal and urinary tracts. The girls’ single bladder was divided and made into two bladders, and each child received a colostomy. The pelvic bones were then divided.
The biggest risk that the surgical team had anticipated prior to separation was excessive bleeding from small, diffuse blood vessels and from the pelvic bones, but fortunately, the twins did not experience excess blood loss. The final incision that officially separated Eva and Erika was made by James Gamble, MD, professor of orthopedic surgery, and Matias Bruzoni, MD, assistant professor of pediatric surgery, at 4:34 p.m. Dec. 6.
"I'm very pleased with the outcome," Hartman said yesterday morning.
The family relied on their strong faith to get them through the long hours of waiting, said mom Aida Sandoval on Wednesday. "When I heard that the feeling in the OR was described as peaceful and everything was working together, I know God was working for these little girls," she said. "It’s amazing how strong these girls are and it’s amazing what their team performed.”
Previously: Twins update: Formerly conjoined twins strong and healthy, Conjoined twins' separation -- a complex feat and Formerly conjoined twins get ready to head home
Photo of Erika and Eva Sandoval just before separation by David Hodges