Conjoined at the beginning, the twin twins were successfully separated with the help of virtual reality.

The surgery for little Bernardo and 3-year-old Arthur Lima took place in Rio de Janeiro, under the direction of Great Ormond Street Hospital in London.

For months, surgical teams tested different types of techniques using projections of twins in virtual reality based on CT and MRI scans.

Surgeon Noor ul Owase Jeelani described it as “something from the space age”.

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Bernardo and Arthur’s is one of the most complex separation processes ever completed, according to Gemini Untwined, the foundation that funded the intervention. Jeelani opened the foundation in 2018.

He said it was the first time a group of surgeons from different countries wore headphones and operated together in the same “virtual reality room.”

The Siamese twins underwent 7 surgeries: the last one required more than 27 hours of surgery and a team of more than 100 healthcare professionals.

“Living on Mars”

Referring to the virtual reality aspect of the surgery, Jeelanie told the PA news agency: “It’s great. It’s really cool to see the anatomy and do the surgery before I put the guys at any risk.”

“You can imagine how reassuring that is for surgeons.”

“In some ways, these operations are considered the most difficult of our time, and doing it in virtual reality is a matter of living on Mars.”

He said the anatomy of the conjoined twins was complicated by the growth of scar tissue after previous failed attempts to separate them, and he was “really worried” about the complicated surgery.

Jeelani said she was “totally devastated” after 27 hours of surgery, in which she only took four 15-minute breaks to eat and drink, but it was “wonderful” to see the whole family excited afterwards.

He added that, as in all cases of conjoined twins, the children’s blood pressure and heart rate were “hit” until they came back together and touched their hands 4 days later.

The twins are recovering in hospital and will undergo six months of rehabilitation.

A change of life

This is Jeelani’s sixth surgery with Gemini Untwined, who has operated on twins in Pakistan, Sudan, Israel and Turkey.

He described the procedure as head of pediatric surgery at the Paulo Niemeyer State Brain Institute in Brazil. Co-directed with Gabriel Mufarrej.

Mufarrej said that the hospital where he works has been taking care of children for two and a half years. He added that the separation would change their lives.

“Since coming to Rio two and a half years ago from their home in the Roraima area, the children’s parents have become part of the family here at the hospital. We are very happy that the surgery went well.”

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Bernardo and Arthur, at nearly four years old, are the oldest craniopagus twins to be separated – that is, their brains fused.

According to the organization, one in 60,000 births results in conjoined twins, of which only 5% are craniopagus.