ABOVE: Neil Mitchell breaks the news the conjoined twins, Trishna and Krishna, have been successfully separated.

• PHOTOS: Inside the operation

NICK MILLER AND THOMAS HUNTER: Conjoined twins Krishna and Trishna are out of surgery following their successful separation.

Head of surgery at Melbourne’s Royal Children’s Hospital Leo Donnan said the plastic surgery to reconstruct their skulls was completed about 4.00pm after their separation five hours earlier.

Surgeons spent more than 27 hours separating the Bangladeshi girls, aged two years and 11 months.

They have been taken to an intensive care unit recovery room, with the next 24 hours crucial to their survival.

The hospital’s head of surgery Leo Donnan praised his doctors, who he said had worked seamlessly to separate the girls.

"This is a once-in-a-lifetime operation that teams would do," Mr Donnan told reporters outside the hospital.
              
"There's relief and it's nice to know we're on to the next stage rather than the previous stage we were at.''

Mr Donnan said the Bangladeshi twins still have a very difficult time ahead of them.
He said the operation went for longer than expected, but the staff took planned breaks, and the twins were well nourished before the operation.

"Everything we have done has gone successfully," Mr Donnan said.

"It was a surreal moment when the pair was separated. And relief. But everyone realised there was a long way to go.

"The girls' physiological condition has improved over the operations, but their bodies now have to recover.

"Everything is in place for the best possible outcome.''
"The mood in the theatre certainly changes now you are dealing with two children rather than one. It's been a very nice stage to move into."

Mr Donnan said Moira Kelly of the Children's First Foundation, who brought the twins to Australia for the operation, was relieved at their separation.

"Moira's reaction was a mixture of relief and joy and all the emotions flooding out," he said.
"For the hospital it's a historic moment, for the girls it's an even more historic moment.

"The girls physiologically, their bodies and the way they react has improved over this time.

"It's a long time in theatre, in the long term there are many risks associated with the girls.

They have got to recover, their bodies have got to recover from this. We've got a lot of unanswered and unknown territory we're moving into. All I can say is that everything is in place for the best possible outcome.

"It went for longer than would have been expected but it's just the nature of what you are dealing with, you have got to go piece by piece carefully and they have done a fantastic job."

Earlier, as the surgery neared the 24-hour mark, Ian McKenzie, the hospital’s director of anaesthesia, emerged from theatre at 8am to report that "the kids are going very well" and but were still to be fully separated.

The operation was initially expected to take about 16 hours. The longest operation to separate conjoined twins joined at the head took four days in April this year in Singapore.

Dr McKenzie said that while progress might appear slow, it was "very fiddly work" and the operation was going "better in some ways" than expected. The girls’ conditions had strengthened as the operation proceeded, he said.

"A lot of the things we were worrying about haven’t happened," he said, but added "it’s not over yet".

"You’ve still got potential for life-threatening things happening."

He said concerns over problems with Krishna’s kidney had eased.

The Bangladeshi orphans were given just a 25 per cent chance of making it through the operation without harm. The hospital’s experts considered some level of brain damage a 50 per cent chance, and death was also a significant possibility.

Although he was not able to predict when the surgery would be finished, he said that was not a sign surgeons were encountering dangerous complications.

‘‘The twins are actually in better condition because the degree of separation has increased. The problem of their circulation affecting one another is actually less,’’ he said.

‘‘The brain is essentially disconnected and the tissue that is still connecting is fibrous tissue with veinous blood vessels in it. The brain tissue is disconnected and the bone tissue is disconnected.

‘‘The more they are disconnected the more we can treat them as individuals. Previously there was always the worry that if you treat one it could go in the wrong direction for the other.’’

Dr McKenzie said the handover to the cranio-facial plastic surgery team was "getting pretty close".

"That is a critical part of the surgery ... There’s quite a lot of steps in that, and they each sound pretty simple, but they’ve each got their own issues," he said.

"Then creating a solid cap over that will be important, and then closing the skin over that. There’s quite a lot of steps in that, and they each sound pretty simple, but they’ve each got their own issues."

While he was still optimistic about the outcome of the marathon surgery, he said "we’re keeping the cork on the champagne".

"Everyone is focusing on the separation point, but that’s going to be the start of a recovery phase which has still got potentially life-threatening complications," he said.

"So far so good, but there is still a long way to go."