Six-hour delay in twins op

Surgeons battling to complete a unique operation to separate adult Siamese twin women fused at the head today hit an unexpected six-hour setback in opening their skulls.

But despite difficulties in separating the skulls of Laleh and Ladan Bijani, 29, doctors were "cautiously optimistic" and said the procedure was "going quite well".

The delay, which came because the Iranian women's skulls were thicker and harder than medics anticipated, is likely to push the operation into a second night.

Though the operation is expected to last around 48 hours, doctors could work far longer as the twins can be kept under anaesthetic for a maximum of 100 hours.

Surgery started yesterday when doctors took a vein from Ladan's right leg to be used to create a new blood vessel for one of the sisters before a craniotomy, or splitting of the skulls, could be performed.

Although the twins have separate brains, they are supplied by a shared major blood vessel. After the skulls were opened surgeons began creating a bypass using this vein so that each brain had a separate blood supply.

Dr Prem Kumar Nair, spokesman for Singapore's Raffles Hospital where the surgery is taking place, said: "Up until now, the twins have taken to the procedure quite well. They are stable. While things have been delayed slightly by the craniotomy, we are cautiously optimistic that things are progressing quite well."

It is the first time surgeons have tried to separate adult twins joined only at the head since the operation was first successfully performed in 1952, and the women have been given only a 50/50 chance of survival.

German doctors turned away the twins in 1996, saying the operation was too risky

But the sisters said they would rather die than continue living together.

In a recent letter, they said: "We've been praying every day for our operation. We are excited about it as we've waited 29 years for it.

"Both of us have started on this journey together and we hope that the operation will finally bring us to the end of this difficult path, and we may begin our new and wonderful lives as two separate persons."

Born in Tehran in 1974, they have different personalities and separate groups of friends. Ladan is more extrovert and talkative, while Laleh is quieter.

If they are successfully separated, Laleh plans to

move to Tehran to pursue a career in journalism, while her sister wants to study law.

The Raffles Hospital offered to fund the £170,000 procedure and assembled an extraordinary team to carry it out: 12 surgeons, five neurosurgeons, six plastic surgeons and a vascular surgeon, five radiologists, eight anaesthetists, a psychiatrist and more than 100 nurses and paramedics.

Dr Keith Goh, the neurosurgeon in charge of the operation, said the women had taken a series of physical and psychological tests, and doctors were certain the operation was necessary. Dr Goh said: "We have to be convinced that this surgery is justified."

Explaining the decision to undergo surgery, Ladan said last year: "We are separate individuals who are stuck to each other. We have different world views, we have different lifestyles, we think very differently about issues."