Twin girl with eight limbs to have surgery*

By Sam Relph and Peter Foster in New Delhi
Last Updated: 5:52pm GMT 05/11/2007

An Indian girl born with four arms and four legs is to undergo a 40-hour
operation tomorrow as doctors try to give her a chance at a normal life.

Lakshmi Tatma is a two-year-old girl named after the Hindu goddess of
wealth who has four arms. She was believed to have been "sent from God"
when she was born to a poor rural family in the Indian state of Bihar.

Two-year-old Lakshmi Tatma plays with her
mother, Poonam, as she waits for her operation

As news of her birth spread among the 500 inhabitants of Rampur Kodar
Katti — a remote settlement without electricity or running water — men,
women and children queued for a darshan, or blessing, from the baby.

However, it will require the latest techniques in medical science to
separate Lakshmi from her "parasitical", headless, undeveloped "twin",
which is joined to her body at the pelvis.

The £100,000 operation will require differently skilled teams of more
than 30 surgeons to work in eight-hour shifts to separate Lakshmi's
spinal column and kidney from that of her twin.

After attempting to transplant the shared kidney wholly into Lakshmi's
body, another team of surgeons will gradually close up her pelvic girdle
while re-orientating her bladder and genital systems. Plastic surgeons
will then graft skin to cover her wounds while an "external fixator"
will be attached to close her pelvis gradually over a three-week period.
;

The procedure has been described as "like shutting an open book".

Without the operation at the Narayana Health City, on the outskirts of
Bangalore, Lakshmi's parents were told their daughter was unlikely to
survive beyond early adolescence.

After more than two months of preparation, Dr Sharan Patil, the
consultant orthopaedic surgeon leading the operation, said that her team
was reasonably confident that the procedure would succeed in helping
Lakshmi to survive.

"Fortunately, Lakshmi has one complete body with a near perfect set of
internal organs," she said.

"Her skeletal system involves two bodies which are fused together at the
level of the pelvis.

"The operation itself, although it presents several challenges, is not
the most complex in the world. What is highly unusual in Lakshmi's case
is precisely how her bodies are fused, almost mirroring each other."

An x-ray photograph of Lakshmi Tatma
An X-ray picture shows how the two
bodies are joined at the pelvis

Her mother, Poonam, and father, Shambu Tatma, who earn about 50p a day
as casual labourers and are both in their twenties, were turned away by
a government hospital when they asked for help to increase Lakshmi's
chances of survival.

However, they were brought to Bangalore after Dr Patil visited their
village.

"We tried to take Lakshmi to hospital but they turned us away and said
nothing could be done," Mrs Tatma said yesterday. "We saved money and
even went to Delhi but the hospitals there turned us away too. Lakshmi
had never once seen a doctor until Dr Patil came to our village and took
an interest in our case.

"I believe that Lakshmi is a miracle, a reincarnation, but she is my
daughter and she cannot live a normal life like this."