Filipino conjoined twins in surgery

Surgery on Carl and Clarence Aguirre, the feisty, dark-haired brothers who are joined at the top of their heads, began at 10 a.m., said Steve Osborne, a spokesman for the Children's Hospital at Montefiore Medical Center in the Bronx.

The boys, veterans of three major procedures, had already been in the operating room for 2 1/2 hours of anesthesia and other preparations, he said.

Their mother, Arlene Aguirre, and her mother, Evelyn Aguirre, accompanied by several Filipino nurses from Montefiore's staff, had left the boys at the door of the operating suite with the kisses and tears. The mother had brought them to New York from the Philippines last September.

Osborne said the room was "quiet and intense" as the first incision was made. He said about 16 doctors, nurses and technicians were on hand. Doctors declined to estimate how long the delicate surgery might take, the hospital said.

By five hours into the surgery, doctors had not yet reached a major hurdle -- cutting a large vein shared by the boys, said Pamela Adkins, another hospital spokeswoman. They were working on smaller veins and other tasks.

Doctors have taken a surgical approach employed only a few times before on conjoined twins, replacing the typical marathon two-day separation surgery with four shorter procedures over 10 months.

Most of the blood vessels around the brain had been cut and divided already, and the boys' brains have been partially separated.

The lead doctors, neurosurgeon James Goodrich and plastic surgeon David Staffenberg, had expressed satisfaction with the boys' readiness for separation, but said that they would postpone it if any warning signs arose, such as swelling or bleeding.

The plan for Wednesday called for making a "window" in the skull, cutting the last major vein still being shared by the brothers, then teasing apart their separate brains in the one small area that had not already been separated.

Once they decided to go ahead, the doctors would complete the separation by removing much of the remaining skullbone. They would have to reconstruct the membrane that cover the brains, and cover the heads with skin.

The doctors have donated their services, as have Montefiore and Blythedale Children's Hospital in Valhalla, where the twins have been living between surgeries and receiving physical therapy.