(AP) - Four-year-old twin sisters born fused at the midsection, with just one kidney and one set of legs, underwent surgery Monday to separate them and allow them to lead independent lives.
Doctors at Primary Children's Medical Center said it was the first known surgical attempt to separate twins with a shared kidney, reports Trend.
Kendra and Maliyah Herrin were rolled into the operating room Monday morning after a tearful goodbye from their parents.
"It was very emotional," said their father, Jake Herrin. "They were more brave than us."
The operation was expected to take 12 to 24 hours, during which surgeons planned to give each girl one leg and Kendra the kidney. Maliyah will be put on dialysis for three to six months until she is strong enough for a transplant of a kidney from her mother, Erin Herrin.
Surgeons also planned to divide the girls' single liver, separate their intestines and reconstruct their shared pelvis.
By Monday night, surgeons had successfully separated the intestines, divided and reconstructed the twins' two bladders and had begun work on some internal organ reconstruction, said Rebecka Meyers, the hospital's chief of pediatric surgery. They planned next to begin reconstructing the shared pelvis, she said.
Surrounded by family and close friends, the girls' parents were being updated hourly by the surgical team's lead nurse and tried to remain upbeat.
"That doesn't mean we're not worried," Jake Herrin said.
The girls were born locked in an embrace, practically face to face. Conjoined twins occur rarely. Estimates range from one incidence in 50,000 births to one in 200,000. Only about 20 percent survive to be viable candidates for separation.
Most separation surgeries occur when the twins are 6 to 12 months old, but doctors advised waiting when they learned the girls shared a kidney.
Subsequent plans for surgery were delayed because Maliyah had difficulty gaining weight and because Erin Herrin's pregnancy last year with twin boys, who are not conjoined, made her ineligible to donate a kidney.
The girls have been in preparation for surgery since June 23, when doctors first implanted 17 expanding balloons into their torso. Filled with saline solution each week, the balloons have been expanding the skin and muscles that plastic surgeons will use in closing the girls' abdomens after surgery.
Some ethicists who met with doctors and the girls' parents questioned separating the twins, but Jake and Erin Herrin, who also have a 6-year-old daughter, decided in February to proceed. They said the girls see themselves as living separate adult lives.
Monday's surgical team had six surgeons, two anesthesiologists, one radiologist, two urologists and 25 to 30 support-staff members.