Mid-surgery details

On a less emotional, more practical note

The most common question right now: how long is the surgery?

I’m wondering the same thing.

The surgeons themselves said they weren’t sure either. There are lots of variables.

But before I get into that, I thought I would explain a bit more in-depth what we learned with the consultation with the doctors. I misunderstood the procedure before yesterday – discard anything I said to you about it before yesterday =).

Each twin has an umbilical cord that is attached to the placenta. Each one is receiving nourishment from it. Think of the cord like the trunk of a tree. How does a tree get nourishment? From the roots, of course! What are the roots in utero? Blood vessels. These blood vessels are not only within the cord, they are also on the outside (kind of like roots are outside the trunk). Where does Twin-to-Twin Transfusion Syndrome (TTTS) come into the picture? It takes place when the external blood vessels are entangled together. Somehow (the doctors don’t know how), the blood from those entangled vessels goes to one twin more than the other. They call this twin the recipient twin – it’s twin B in our pregnancy. The smaller of the two is called the donor twin – it’s twin A in our pregnancy.

This is a concern for several reasons.

1. The recipient twin can get too much nutrition, grow too fast, and be unable to handle it. Cardiac problems ensue, including – but not limited to – cardiac arrest and heart attacks. It’s a fatal condition.
2. The donor twin can get too little nutrition, not grow fast enough, and not sustain life. With less nutrition, there’s subsequently less amniotic fluid, leaving less room to grow.
3. The recipient twin’s amniotic sac grows large because of the increased amniotic fluid. The sac then presses against the placenta, preventing the cilia from working most efficiently – these cilia gather nutrients, which then nourish the babies. When these cilia don’t work well, the lack of nutrients is particularly dangerous for the donor twin.
4. Because the blood vessels are entangled, if either twin has problems, then both twins have problems. What happens to one, happens to both. So, if the recipient has a heart attack, the connected blood vessels drag the donor down to death, too. Or if the donor can’t live, she causes the recipient to die, too.

So that’s where this surgery comes in. They use a laser to cauterize all the vessels that connect the two twins. They said that if even one connection is left, then the surgery doesn’t work. So that’s why they don’t know how long the surgery lasts; it completely depends on how many vessels there are connecting them – something they don’t entirely know until they are in the middle of surgery.

I mentioned yesterday about concerns whether twin A has enough of the placenta. This surgery really can’t do anything about that problem; either her trunk and roots are well-placed or they’re not. They can’t tell about placement until during the surgery – so we’re praying for good results on that front, too.

Updates post-surgery coming soon…
~Jeff