Dr. Sharan Patil
Chief Orthopedic Surgeon, Sparsh Hospital, Bangalore, India
Thursday, November 8, 2007; 11:00 AM

Doctors in southern India completed a 24-hour operation Wednesday on a girl born with four arms and four legs that surgeons said will give the 2-year-old a chance at a normal life.

The surgery went "wonderfully well," said Dr. Sharan Patil, who led a team of more than 30 surgeons in the marathon procedure to remove Lakshmi Tatma's extra limbs, salvage her organs and rebuild her pelvis area.

Dr. Patil was online from India on Thursday, Nov. 8, at 11 a.m. ET to discuss the operation, the current condition of Lakshmi and her recovery.

A transcript follows.

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Fairfax, Va.: How prevalent is the condition that the little girl had? How often does this kind of thing happen with twins in the womb?

Dr. Sharan Patil: Thanks, There are variable reports one in 1,50,000 pregnancies have conjoint twins, however only 10 to 15% of them live.

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Washington, D.C.: How difficult was the operation? Has the complete other body been removed from Lakshmi's own body? How was this done?

Dr. Sharan Patil: Thanks, There was a complex surgery which took 27 long hours involving different specialities including orthopaedic surgeons,pediatric surgeons, neuro surgeons, p lastic surgeons etc.

The parasitic twin of lakshmi has been completely removed.

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Washington, D.C.: Why did the absorbed fetus have four limbs but no head?

Dr. Sharan Patil: Difficult to say. It is a kind of developmental anomally . Development has arrested at some time during formation of twins.

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Washington, D.C.: Can you tell us whether the movement of Lakshmi's second set of limbs was controlled by Lakshmi herself? Or was there some kind of residual nervous system control from the partial twin?

Dr. Sharan Patil: There was some kind of residual nervous system which was controlling the parasitic twin.

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Washington, D.C.: Can you tell us whether Lakshmi has normal digestive function and reproductive organs?

Dr. Sharan Patil: Lakshmi has normal digestive function however reproductive organs are under developed.

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Reston, Va.: This is Srikanth Kondeti. First of all congratulations to your team for this Grand Operation successful.

But I have a question though.

How far this is success in her long-term LIFE? Is that safe for her?

Dr. Sharan Patil: Thank you very much. If we can get through this equiped face, we could be looking at a very solvable situation for life.

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Washington, D.C.: Will she eventually be able to walk, also how was she able to use the bathroom before the surgery?

Dr. Sharan Patil: Our expectations are she should be able to walk eventually. She had two anal openings on either side of the body. Internally there was duplicaton of the terminal bowel.

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Washington, D.C.: How is she doing today? Does she have a long recovery and much physical therapy ahead?

Dr. Sharan Patil: She is progressing satisfactorily. No set backs. She will require physical therapy.

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Ability to walk: Does this mean that she will be able to walk at some point? Or at least have the chance to develop that far?

Dr. Sharan Patil: We are optimistic. She will be able to walk at some point.

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Philadelphia, Pa.: I understand that Lakshmi's family is poor, is there any way for us to help?

Dr. Sharan Patil: You can help Lakshmi through Sparsh Foundation, a charitable wing of sparsh hospital either by logging on to our website www.sparshhospital.com or contact Dr. Mamatha Patil: +919845477435. We would greatly appreciate it.

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washingtonpost.com: Sparsh Hospital

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McLean, Va.: I understand some in India believe she is considered a goddess because of the extra limbs. How prevalent is this belief? Was there hesitation on anybody's part to do the operation? Does it get into a religious thing?

Dr. Sharan Patil: There are few people who would think like that. There was no hesitation either on our minds or on the parents of Lakshmis mind about the need for an operation. However considering the mortality rate of about 25% there was hesitation & aprehensions on our minds.

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Washington, D.C.: Did the parents wait until Lakshmi was 2 years old before the surgery? Why wasn't it done earlier/before? Will she need psychological counseling?

Dr. Sharan Patil: They did consult somebody regarding surgery while she was young. But were discouraged saying high mortality rate. She will definetely need psychological counselling & prolonged physical therapy.

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McLean, Va.: This is a very inspiring story. You and your team should be very proud.

Outside of the obvious benefit to this young girl, are there other medical applications for the techniques used in this surgery?

Dr. Sharan Patil: Yes we are all proud that everything has gone according to our plan. The whole affair requried meticulous planning, execution, microsurgical techniques & most importantly team effort.

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Alexandria, Va.: This was an amazing surgery. Medical science has come so far in being able to give people like Lakshmi a normal life.

She looks like a happy child. Will she need psychological treatment eventually to understand what happened to her, or are her memories of her additional limbs likely to fade away quickly?

Dr. Sharan Patil: As i have said she will need psychological help but she is a very small child & is unlikely to remember this for a very long time.

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Washington, D.C.: Congratulations on your remarkable achievement and my best hopes for this young girl.

Is it known if there was a genetic abnormality of some kind that led to this condition, or did something just go wrong in the womb?

Dr. Sharan Patil: There are many theories on why conjoint twins are formed like the fusion & fission theories. It is difficult to say which one is responsible in lakshmi's instance.

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Washington, D.C.: Will the girl be able to develop as a normal child/adult? Will her own limbs and body now develop as normal children do?

Dr. Sharan Patil: Lakshmi is only two years now & she has atleast 13 to 14 years further development. Normally children have great remodelling potential which means she by all means should develop as a normal child adult and be able to use her body as a normal child.

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Chantilly, Va.: Who pays for such an operation? Will there need to be others or is the surgery essentially done?

Dr. Sharan Patil: In lakshmi's instance, Sparsh Foundation, a charitable wing of Sparsh Hospital is paying for all the expenses. If there are other children like that there shall be definetely a way to work about if surgery is going to be beneficial for the child.

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Washington, D.C.: Have you performed other surgeries similar to this? If so, what specific conditiions were prevalent? Have you ever seen a case like this?

Dr. Sharan Patil: This was unique & first of its kind performed first time in India. There are very few others performed world wide. I have not performed surgery of this magnitude so far. However we have recently performed similar surgery where there was a part of the limb & genetalia developed out of the back of a boy.

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Rowlett, Tex.: Sir, I have no questions. Just the utmost respect for you and your team who performed this miracle, giving to this child a normalcy of life. What you have done was truly accomplished through divine guidance. Bless you and your team, and may this child know only happiness and good health throughout her life. Thank you.

Dr. Sharan Patil: Thanks a lot, your wishes certainly help lakshmi to recover from this difficult phase in her life.

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Annapolis, Mc.: Will you continue to be her doctor? Will you follow her progress and be available to the family in the future?

Dr. Sharan Patil: Definitely yes, lakshmi is very close to my heart and i will go out of the way to help her & look after her in the future.

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Los Angeles, Calif.: Is it me or do there seem to be a lot of conjoined twins in the world in the past 20 years? Could there be an environmental issue due to increasing levels of toxic hazards we humans are levying into our precious earth?

Dr. Sharan Patil: Conjoint twins are very rear. We donot know much about the environemental issues at the moment.

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North Carolina: Has this child's DNA been tested? Would the number of limbs suggest that this little girl is a conjoined multiple birth? Is chimerism a possibility?

Dr. Sharan Patil: The genetic angle of this has not been researched much. It is definetly a conjoint multiple birth. Cant comment about possibility of chimerism.

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Washington, D.C.: Is Lakshmi the little girl's real name? I did some research which said that the name was Hindu and is the goddess of wealth, love and beauty. Is that the name her parents gave her?

Dr. Sharan Patil: Lakshmi is the girl's real name. (We have obtained informed consent from the parents to reveal her name). The parents infact named her as lakshmi because hindu godess in that name also has 8 limbs. She is portrayed as godess of wealth, love & beauty.

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Gaithersburg, Md.: How is a little 2-year-old girl prepared for such surgery?

This story makes me grateful that I was born a fraternal twin.

All the best to little Lakshmi and her family.

Dr. Sharan Patil: It took couple of months from the time i saw little lakshmi in her native place, to the day of surgery. She is admitted in the hospital from past one month when several investigations have been done for planning & preparing for surgery. Thanks for your wishes.

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Silver Spring, Md.: Not to be gruesome, but what do they do with the removed limbs? Bury them? Destroy them? Send them to a lab for study?

Dr. Sharan Patil: We have send the amputated limbs for histopathelogical study.

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Houston, Tex.: As a Bangalorean I am very proud that this amazing surgery happened in our fair city! COngratualtions to all of you!

One question: What happens now to the whole family? Will they go back to Bihar? Or will they stay in Bangalore? What kind of work or employment will the parents do? Can something be arranged to improve their economic situation?

Sriram

Dr. Sharan Patil: Thanks for your wishes. We are working on rehabilitating them in Bangalore. But it is a tough job. We have to consider the family social situation as well. They may not be willing to stay here for ever. We are insisting that they should stay till the rehabilitation reaches fairly a reasonable stage. We are working with NGO to see if their economic situation we improve.

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Arlington, Va.: Were Lakshmi's own limbs in the nomal placement on her body? Was it just a matter of removing the twin, and that her own limbs and functions will be normal as one person?

Dr. Sharan Patil: They were not in the normal place as there were crowding of all the limbs & other parts around pelvis. The abnormalities were complex as there were mixing up of organs between the twins. We are hoping that she will be a normal person.

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Dr. Sharan Patil: Please pray for young lakshmi, so that she recovers fast. Please visit www.sparshhopsital.com for updates on Lakshmis progress.

We thank all the readers for their questions & wishes.