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Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships

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Abstract

Background

Diagnosis and management of conjoined twins are constantly evolving [1]. New imaging techniques provide important anatomic details and help in planning the separation procedure [2, 3]. Despite these technological advances, however, the complex arrangement of conjoined organs is somewhat difficult to interpret, leaving unresolved questions at time of surgery. The authors present a video demonstrating laparoscopy as an adjunct in the preoperative planning of separation of ischiopagus tripus conjoined twins as well as illustrating the complex anatomy in a combination of video, drawings, and radiologic imaging. To date, this is the first time that laparoscopy has been used in preoperative assessment of conjoined twins.

Methods

After elective cesarean delivery, ischiopagus tripus conjoined twins were thoroughly evaluated with conventional imaging, including plain radiographs and computed tomography scan with three-dimensional (3-D) reconstruction images. The anatomy of the gastrointestinal and genitourinary tracts was further defined with barium enema, retrograde pyelography, and cystoscopy. In addition to these tests, diagnostic laparoscopy was performed at time of tissue expander placement. An angled scope, introduced through a 5-mm umbilical port, was used to visualize the intraperitoneal organs as well as all accessible retroperitoneal structures.

Results

Laparoscopy provided useful information regarding the bowel distribution between the twins. In addition, it helped demonstrate the relationship of shared solid organs with other intra-abdominal structures and identify anatomic landmarks used in the subsequent separation of the twins. Finally, laparoscopy helped confirm the presence, number, and morphology of the internal female genitalia.

Conclusions

Diagnostic laparoscopy is a useful tool in evaluation of ischiopagus tripus conjoined twins. It is an important adjunct to preoperative studies in preparing for an expeditious and safe separation procedure.

References

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    Mackenzie TC, Crombleholme TM, Johnson MP, Schnaufer L, Flake AW, Hedrick HL, Howell LJ, Adzick NS (2002) The natural history of prenatally diagnosed conjoined twins. J Pediatr Surg 37(3):303–309

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    Martínez L, Fernández J, Pastor I, García-Guereta L, Lassaletta L, Tovar JA (2003) The contribution of modern imaging to planning separation strategies in conjoined twins. Eur J Pediatr Surg 13(2):120–124

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    Kingston CA, McHugh K, Kumaradevan J, Kiely EM, Spitz L (2001) Imaging in the preoperative assessment of conjoined twins. Radiographics 21(5):1187–1208

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Disclosures

Authors Blanco, Davenport, Kane, Losee, and Schneck have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Timothy D. Kane.

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Supplementary material 1 (WMV 100703 kb)

Supplementary material 1 (WMV 100703 kb)

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Blanco, F.C., Davenport, K.P., Kane, T.D. et al. Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships. Surg Endosc 26, 1777 (2012). https://doi.org/10.1007/s00464-011-2069-3

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Keywords

  • Conjoined twins
  • Ischiopagus tripus
  • Laparoscopy