- [Narrator] Saturday, October 24th, 2020.
Surgery day for conjoined twins Abigail and Micaela
at UC Davis Children's Hospital.
Connected at the head for their first nine months of life,
they will finally become two fully separate babies.
- It's one of those cases that captures the imagination.
- [Narrator] After months of careful preparation,
including practice with high-tech tools,
rehearsals become reality
for members of the surgical team,
more than 30 of them.
In the operating room that was custom built
for this level of surgical complexity
hang detailed plans and timelines,
and a portrait that reminds everyone what's at stake.
- These are our babies.
There is a family on the other side
that's praying for these little girls,
and we can't lose focus of that, no matter what happens.
- [Narrator] The babies had breathing tubes
inserted the night before,
so the team is ready to begin its long list of procedures
from the moment their tiny patients
entered the operating room at 7:53 a.m.
They know they are in for a marathon.
The entire event could take 24 to 48 hours.
- You're gonna move sideways
and move the vents out the way sideways.
- [Narrator] Pediatric anesthesiologist Raj Dhamrait
leads the team that will monitor
the twins' vital life functions and maintain their safety.
The twins' shared anatomy complicates the anesthesia.
- The two children were connected somehow,
but we really didn't understand how one child
would affect the other child.
So there was all this balancing that was happening,
and that was continuous.
One, two, three, and move.
- [Narrator] During the surgery,
the twins have to be turned over several times,
a precarious move.
- Pull the legs out.
- [Narrator] They will be turned over a total of five times
throughout the procedure.
- Let the surgeons in to take the heads.
- [Narrator] Nursing lead Aida Benitez steps out
to give the twins' family an update.
- So they're doing good,
I'm giving you a good report card on them, okay?
- [Narrator] Back in the OR, the team readies
for its next steps.
Plastic surgeon Granger Wong inserted a tissue expander
under the girls' scalps three months prior.
Now he makes the initial incisions and removes it.
The custom-made expander encouraged the growth of new skin,
enough to cover the girls' heads after separation.
- We'll have that anatomy
based on where that suture line is.
- [Narrator] The neurosurgery team,
led by pediatric neurosurgeon Michael Edwards,
reviews their plan one more time,
referring to a custom printed 3D model
of the babies' skulls.
With the tissue expander removed, for the neurosurgeons,
the painstaking and meticulous task of dividing veins
and brains begins.
They know the most challenging part
will be the fistula ligation.
That's clipping and dividing a large connection
shared between the babies.
Hours pass and then the neurosurgery team
makes an unwelcome discovery
when they reach the critical step of cutting the fistula.
Their preparation had led them to believe
that abnormal connection would be plainly visible.
- Everybody said, well, when you open up, you'll see it.
Well, when we got to it, we couldn't see it.
It wasn't there.
- [Narrator] The connection is covered by a tough membrane
called the dura, and it can't be seen.
Under pressure, they have to make a decision.
- Okay, do we cut into this dura and try to open it,
knowing that there's a big blood vessel
moving a lot of blood, or what do we do
to try to coagulate and control this fistula?
So we finally said, okay, we gotta up and do this.
- [Narrator] They go in cautious and exacting.
The wrong move could lead to a massive brain bleed,
even bleeding to death.
After tense moments,
the cutting of the fistula is a success.
Benitez calls the twins' mother.
- I asked her, are you still out front and on the lawn?
And I went outside
and actually delivered the news in person.
(people laughing)
- [Narrator] Outside the hospital,
the babies' mother Liliya holds vigil,
waiting in the company of supportive family and friends.
- We're just waiting for the great news,
which is coming from the operating room
and yeah, just praying.
- Okay, reach in and pull the legs out.
- [Narrator] The work continues.
The babies are lifted up and over again.
Blood transfusions are needed.
Then after 3:00 a.m., 20 hours into the procedure,
and nearly 10 months into Abigail and Micaela's lives...
- Cranial separation, yay!
(staff cheering and applauding)
- [Narrator] For the first time,
there is space between them.
This moment is for Benitez to declare for the record.
- I looked over, and they had tears in their eyes,
and I looked to my right and they had tears in their eyes,
and I finally choked it out, "It's 3:28."
- One, two, three, move.
- [Narrator] It's the first time in their lives
Abigail and Micaela are lying on separate beds.
Dr. Wong returns to reconstruct the twins' skulls
and close the incisions.
- We're glad we were able to accomplish our goal,
but we're tired.
- [Narrator] 7:49 a.m., almost exactly 24 hours
from when they entered the OR in one bed,
the twins leave in two.
For the team, a swelling of relief,
pride, and congratulations.
- It's a Herculean effort
that we've all contributed to.
- I think everybody will be telling the story
of these last 25 hours to everyone
for the rest of their lives.
- Mom is beside herself.
I actually thought she disconnected
when I called to tell her that she had two little girls
as of 3:28 in separate beds.
She couldn't talk,
and then she just broke down.
- [Narrator] The twins will have a long recovery here
in the UC Davis Pediatric Intensive Care Unit, or PICU.
A new day, a new life, as twins, no longer conjoined.
- When we rolled into the PICU,
the sun was starting to peek out over the buildings,
and to me, they just looked like angels.
The sun hit their foreheads,
and I realized this is the handoff.
Our job here is done.