Imagine spending five months of your life face to face with your sister. Grabbing at her ear, her arms and legs constantly playing with yours. And then one day, suddenly you and your sister are truly separate beings.
That's what happened to Abbigail and Isabelle Carlsen Friday, as a team of 18 doctors and a couple dozen other medical staff separated them.
Their parents, Jesse and Amy, are very happy.
"If any of you looked outside today you noticed it was cloudy and rainy and the sun was nowhere to be seen," said Jesse Carlsen. "And I think that's because it was in that operating room with our girls and this team. And today a lot of our prayers have been answered."
Doctors say the surgery was difficult, but it went as planned. Abby and Belle were connected at the abdomen and chest. Their hearts, livers and small intestines had to be separated. Surgeons also removed their gallbladders.
The girls' parents visited with family as the surgery progressed. They got updates from the hospital staff every few hours. Jesse says at first it was hard to see the nurses coming out of surgery, because they didn't know what news to expect.
"The day got easier as the updates got better, and before you knew it a pinochle game broke out," he said.
Lead surgeon Dr. Christopher Moir said three issues made the surgery complex. The first was the girls' hearts.
"Belle's heart actually overlapped Abby's heart such that when we came to do the separation, her heart would perturude out of her body. We expected that to be a problem, and it was," said Moir.
Doctors were also concerned Belle's heart wouldn't be adequately covered by her chest wall. But they were able to place Belle's heart in its normal place without any protrusion, and cover almost all of it with her chest wall. Abby's heart is completely covered by her chest wall.
The next problem was separating the girls' livers.
"Not only were they joined together, but they were skewed and growing into each other's body," said Moir.
Moir said computer images of the girls' bodies helped doctors find a way to reconstruct the livers successfully.
The last complication was the small intestine. Moir says they did not know how much intestine the girls shared, but it turned out each had enough.
Both girls will stay on respirators for a time, since the surgery tightened their abdomen and chest cavity. Later Saturday, doctors will see whether they can breathe on their own.
The girls did great. The credit goes to them. I think they are tough little girls.Dr. Randall Flick, lead anesthesiologist
In the first few days they'll be watching for bleeding and heart problems. They'll also be watching for any digestive complications.
Dr. Phil Fischer says if Abby and Belle continue to remain stable, no future surgeries will be needed. Fischer is the medical director of Mayo's Children's Hospital. He says doctors' extensive imaging was key to the success of the surgery.
"The pictures we were able to take, and then reconstruct in three dimensions, helped remove a lot of the questions about how blood flow was and how the organs were shared. So the surgeons went in today with a big head start compared to how they went in 10 years ago," said Fischer.
Abby and Belle are going through a sudden and dramatic change. They've shared the same space, and been by and large in the same position for five months. But Fischer says infants bounce back quickly. And they likely won't remember being conjoined.
"There'll probably over the next few days be some surprises for them -- as best we can interpret five-month-old reactions -- by not having the sister so close. But also by being in different positons and different IVs and different things going on around them," said Fischer.
The girls are currently in the ICU on separate beds. Their mom, Amy, said she thinks they look beautiful.
"They look great. They're just amazing. They're wonderful."
Amy says she hopes she and Jesse are the first thing the girls see when they wake up.