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. 2022 Nov 18:15:2669-2678.
doi: 10.2147/JMDH.S390419. eCollection 2022.

The Multidisciplinary Perioperative Management of Conjoined Twin Separation Surgery During the Pandemic

Gezy Giwangkancana  1   2 , Dikki Drajat Kusmayadi  3 , Fiva Kadi  4 , Arie Utariani  2 , Zahran Haryawan  5
Affiliations

The Multidisciplinary Perioperative Management of Conjoined Twin Separation Surgery During the Pandemic

Gezy Giwangkancana et al. J Multidiscip Healthc. .

Abstract

Background: Conjoined twin management, especially separation surgery, is a complex procedure which requires multidisciplinary work in the perioperative period. This complexity further increased with the COVID-19 pandemic, where social distancing protocols and the general reduction in non-COVID-19-related health-care services added a new dimension to the modern form of teamwork.

Methods: This study focused on the process of preparation for conjoined twin separation surgery during the pandemic from March 2020 to May 2022 with pre-pandemic era comparison. We described the decision-making process and the available facilities in terms of equipment, human resources, and the inclusion of information and technology.

Results: Among the essential requirements for separation surgery are doctors from various disciplines, pediatric anesthesiologists, nurses from different specialties, radiologists, rehabilitation specialists, nutritionists, pharmacists, psychologists, social workers, public relations, and information and technology staff. The team composition may change depending on the patient's clinical characteristics and social needs. Surgery preparation consists of a prognostication period, preoperative management, surgery, and discharge.

Conclusion: Complex surgery such as conjoined twin separation can be managed effectively by a team of multidisciplinary experts. The application of information technology, to manage changes in multidisciplinary work pre- and post-pandemic, can reduce pandemic-related social restrictions while maintaining effectiveness and increasing efficiency.

Keywords: COVID-19; coronavirus; emergency; management; operating room; pandemic; surgery.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Conjoined -Twin Management Team Members.
Figure 2
Figure 2
Preparation for Conjoined twin separation surgery. (A) Note the use of manikin-babies for simulation purposes. (B) Preoperative simulation involving all team members. (C) Media room and spokesperson. (D) Information and technology control room for education, reporting, and information purposes. (E) Two color codes (pink and blue) were used to mark the patients, team members, and equipment.
Figure 3
Figure 3
Conjoined Twins Separation. (A) Anesthesia induction. (B) Surgery, note that the surgical team leader (doctor with glasses) continuously supervises different surgical departments. (C) Twins separated, note that team pink and team blue (marked by colored hair caps) were focused only on one twin each. (D) Pediatric critical care. (E) Discharge meeting with parents, rehabilitation specialist, pediatrics, and social worker. (F) Discharge.
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