Surgeons from Melbourne's Royal Children's Hospital will attempt to separate 14-month-old conjoined twins who have arrived in Australia today after being flown in from their home in Bhutan.
Nima and Dawa were born conjoined at the chest facing each other and scans carried out in Bhutan suggested they shared a liver.
Charity organisation the Children First Foundation is funding their flights and surgery, which doctors estimate could cost more than $300,000.
The two girls and their mother, Bhumchu Zangmo, arrived at Melbourne Airport about 11:45am and will meet with doctors tomorrow to begin assessments before what is expected to be an eight-hour operation.
"Based on reports we've had from the doctors and the imaging we've seen, they would appear to be joined and sharing mainly a liver, but we don't know the exact anatomy of that," said Mark O'Brien, head of surgery at the Royal Children's Hospital told ABC Radio Melbourne.
"One of the first things we'll have to do is assess them both physiologically to see how healthy they are and how fit they are for surgery and then to do some detailed medical imaging to assess the surgical plan.
"As you can imagine, it involves two anaesthetists, two sets of nursing teams in the theatre environment, it creates a level of complexity that's out with the normal practice," he said.
"We've been planning for this for a few weeks and we've liaised with all of the relevant teams to make sure that we have the appropriate space and the appropriate resourcing, and the nursing staff, anaesthetic staff, medical imaging, ICU, everybody that may have to be involved has been prepped.
"We hope not to need places like the intensive care unit but they've been briefed as best they can."
Doctors hopeful both twins can survive
Dr O'Brien said based on the information available, the surgery required to separate the sisters appeared to be "at the easier end of the spectrum" of conjoined twins cases.
"Sometimes you have to make a decision that one twin would not make it … that does not appear to be the case with these two and we are hoping with the information we have to date that both twins will survive the surgery and go back to Bhutan," he said.
"It's a privilege to be able to give these children a very different life trajectory to the one that they're currently set on and it's something that is not possible in their home country."
Dr O'Brien estimated the costs of surgery were likely to be more than $300,000 "assuming a straightforward and uncomplicated surgical and medical pathway".
The twins will need to gain weight and improve their nutrition before the surgery goes ahead, according to a doctor who recently visited the twins in Bhutan.
Chris Kimber is the head of children's surgery at Monash Children's Hospital and told ABC Radio Melbourne the hospital helps train doctors in Bhutan.
He said the twins were healthy when he visited them earlier this year.
"In July they were pretty good, they were feeding well, gaining weight and looked well," Associate Professor Kimber said.
"But in the last few weeks they had lost weight, their mother had reported that they were fighting, scratching each other and that she was unable to get both of them to sleep together, that there was always one of the twins awake and annoying.
"And as such they'd actually lost weight and they'd developed significant infective skin lesions related to the scratching."
He said without the intervention of the charity organisation, the surgery would not be possible for the Bhutanese twins.
"For those of you who aren't familiar with Bhutan, it's the most remote and mountainous kingdom virtually in the world," he said.
"There's 800,000 people there that are widely spread out throughout valleys and very remote regions."
Victorian Health Minister Jill Hennessy said she thought most Victorians would be touched by the case.
"This has been an extraordinarily complex preparation process involving very important considerations and decisions being made about the possible opportunities that could be offered to the twins by our clinicians here in Melbourne," she said.
"It's a matter of incredible pride that our teams are going to be putting their hands up to work and give these beautiful little girls their best chance at having a full and dignified life.
"To use your incredible clinical skills and your sense of compassion to step up to support this incredibly complicated case I think speaks not just to the 'hero status' that we should hold our clinical teams in, it also speaks to our very strong ethical compass around supporting all children."
Doctors at the hospital made international headlines when they separated conjoined Bangladeshi twins Trishna and Krishna almost a decade ago, who were conjoined at the head
abc.net.au
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