Across two continents, surgeons used virtual reality to prepare to separate conjoined twins

In Rio de Janeiro, surgeons separated 3-year-old conjoined twins Arthur and Bernardo Lima in June. When the twins were born, they were attached at the head, their brains intertwined. Separating them would require dozens of complicated surgeries.

To prepare, the twins’ doctors in Rio used 3D-printed models of the kids’ brains and they practiced the surgeries in virtual reality, using goggles and controllers while connected to another medical team in London that had done this before.

Marketplace’s Marielle Segarra spoke with Noor ul Owase Jeelani, a pediatric neurosurgeon at London’s Great Ormond Street Hospital. His team led the VR training, and then he flew to Brazil to be one of the lead surgeons on the case. The following is an edited transcript of their conversation.

Noor ul Owase Jeelani: When you discuss these operations, you really do need to be able to say, “OK, if we turn the two brains 30 degrees in this direction, then we can approach this blood vessel from this orientation. And then once we’ve done that, then you need to unturn them by 15 degrees.” To explain that just using words is near impossible. So what we managed to do with Brazil was invite them to join us in our VR theater, and then use the visualization tools we’ve just spoken about and talk about the some of the critical steps of the surgery. So that was the first, and that was quite reassuring for everybody involved.

Segarra: You’re probably used to, as a surgeon, holding certain tools, and it becomes muscle memory, I’m sure. Like, how to make certain movements with your hands. But if you have controllers, that’s a different kind of movement that you’re doing, right?

Jeelani: You’re absolutely right. I remember the first time I used the controllers, it did take 10 minutes or so to just get the hang of it. But I think maybe as surgeons, we have the skills to be able to sort of — hand-eye coordination just works that well. After about 10 minutes, it was fine. I felt fairly comfortable using it, and the team in Brazil, again, once they got the hang of it, they were able to do it.

Segarra: Were you all also practicing with the regular tools as a supplement?

Jeelani: Oh, yeah. This did not substitute any of our regular sessions. So the 3D models were made in London, the 3D models were made in Brazil. So we still had our Zoom conversations with the 3D models in our hand. So all of that happened. VR was additional to everything else.

Segarra: And it sounds like it gave you visualization into something that you wouldn’t have had otherwise.

Jeelani: It did, it did. Now, I think that’s a definite yes for virtual reality — to be able to see those two brains and how they twist around each other, the various crevices, to be able to see all the blood vessels and how they course between the two brains and around the two brains. It’s very difficult, near impossible to see it on 2D structures, on 2D screens, and then make a high-fidelity 3D model in your head. Particularly as surgeons, we’re used to, I’m used to, dealing with one brain, one set of blood vessels, one head at a time. So my brain is almost programmed to do one. And now when you put two in it at the same time, it’s almost like your computer starts to malfunction, because it’s getting two feeds at the same time. It’s a bit like that. So the craniopagusness makes it really complicated to just do the 3D visualization in our heads, which we would do for our other cases. But the 3D models help with that, and the virtual reality helps with that as well.

Segarra: What do you think will come next in terms of virtual reality and surgical care?

Jeelani: Yeah, so I get asked the question: Do I think that virtual reality in time will be good enough? Could I have done this surgery whilst I was in London and the surgery happened in Rio? Well, in 2022, no. But is it possible that we’ll be doing something like this in the next five to 10 years? I think the answer is yes. There is still quite a lot of R&D we need to do, but there is a lot of work that’s happening in this field. And I think, certainly in the next 10 years, but maybe even before that, we’ll be in a position where we’ll feel comfortable enough to guide surgeries like this from a distance.

Related links: More insight from Marielle Segarra

Jeelani is part of the nonprofit group Gemini Untwined, whose mission is to give medical teams around the world the skills and knowledge they need to do these surgeries on craniopagus twins (the name for twins joined at the head). One in 60,000 births results in conjoined twins, and 5% of those are craniopagus twins, according to the group.

When we talked, Jeelani also pointed out there are things VR still can’t do. He can hold onto a model of a brain in VR, turn it over and around. But he can’t press down on it with a medical spatula and see it react the way that a human brain would.

He also said the twins are doing well — Arthur should be ready to leave the hospital soon, and Bernardo within a few weeks.