• Article
  • July 5, 2017

What it Was Like for This Team to Separate Conjoined Twins

Here's an inside look at the preparation and surgery at Maria Fareri Children's Hospital.

Ballenie and Bellanie with some members of the Maria Fareri Children’s Hospital surgical team that successfully separated them.
Ballenie and Bellanie with some members of the Maria Fareri Children’s Hospital surgical team that successfully separated them.

Michael Gewitz greeted Laurilin and Abel Camacho with four words they had been longing to hear: "Two babies, two babies!"

Gewitz, M.D., who is the William Russell McCurdy Physician-in-Chief at Maria Fareri Children's Hospital in Valhalla, New York, was congratulating the Camachos on the successful surgery that had just separated their conjoined twin daughters, Ballenie and Bellanie.

The Camachos could finally exhale following an agonizing wait during the 21-hour surgery. And for the more than 50 members of the surgical team responsible for the separation of the twins—a first for Maria Fareri Children's Hospital—it marked the culmination of months of planning and preparation.

It all began as a chance encounter. A former Maria Fareri Children's Hospital employee happened to be visiting family in the Dominican Republic where she heard about the conjoined twins, who were born there in February 2016. She set out on a mission to see if someone at the Valhalla hospital could help.

Once it was determined that a separation surgery was feasible in spring of 2016, Gewitz and a multi-disciplinary team at Maria Fareri Children's Hospital used telemedicine technology to examine the babies from more than 1,500 miles away. The Camacho family was then brought to New York, where the team's efforts would ramp up in preparation for the complex separation surgery.

Outside-the-box thinking

This multi-disciplinary surgical team—led by pediatric surgeons Samir Pandya, M.D., and Whitney McBride, M.D.—began a series of collaborative planning meetings, advanced screenings of the twins and practice walk-throughs in preparation for the surgery.

Joined at the lower torso, the Camacho twins presented the medical team with a challenge across a number of systems: from neurological and gastrointestinal to cardiovascular, orthopedic and more. To map out a plan for the surgery, the team used 3-D models of the girls’ anatomy. They also got creative.

"One of the surgeons had stuffed animals—Mickey and Minnie Mouse—and he had sewn them together at the place where the twins were joined," says Nancy Inglese, B.S.N., RN, CNOR, head nurse, Children's Operating Room at Maria Fareri Children's Hospital. "We had them on the operating table so we knew how to position them…it was really helpful."

Since the goal was two separate babies, the surgical team split into two squads, one dedicated to Ballenie, the other to Bellanie. Everything, from the medical equipment to the surgical tools, was color-coded either pink or blue. This way, there would be no confusion about which team was taking care of which baby on the day of the surgery.

The moment of truth

On January 17, 2017, the two color-coded surgical teams convened in Maria Fareri Children's Hospital's largest operating room. After months and months of planning, the time had finally come. "It was a moment like, 'Wow, we're really going to do this,'" says Inglese. "We were just so proud of each other."

As a trauma center, Maria Fareri Children's Center frequently performs the specialized procedures that were performed on the twins. But Gewitz says "putting it all together in one set of patients" at the same time presented an extraordinary challenge. "We had to be ready for everything," says Inglese. "But it could not have gone more perfectly. We hit no stumbling blocks whatsoever—we couldn’t have planned it better."

Two babies, countless lessons

Today, Ballenie and Bellanie are thriving. Though they are still undergoing outpatient therapy, they were released from the hospital in March, and Gewitz says they may be able to return to their home in the Dominican Republic soon.

For the team at Maria Fareri Children's Hospital, the experience provided important lessons they can apply down the road, not only for potential future conjoined twin surgeries, but for the children they treat on a daily basis. And there was a renewed sense of what they can accomplish as a team.


"The coordination of effort at all levels throughout the hospital, from senior administration to the janitorial staff and everyone in between was tremendous," says Gewitz. "It takes that kind of effort and dedication to get these kinds of things done."

And the reward for the surgical team? "Happiness for the family and pride for the team," says Inglese. "I've been a nurse for 30 years, and this was definitely the highlight of my career."

Watch a video that tells the story of Ballenie and Bellanie's separation surgery, step by step.

Send questions or comments to magazine@childrenshospitals.org.