Laparoscopic robot-assisted pancreas transplantation

U. Boggi¹, F. Vistoli¹, S. Signori¹, S. D'Imporzano¹, G. Amorese², G. Consani², F. Guarracino³, P. Marchetti⁴, D. Focosi⁵, F. Mosca^6
1 Division of General and Transplant Surgery - Pisa University Hospital , Pisa, Italy; ² Division of General and Vascular Anesthesia and Intensive Care - Pisa University Hospital, Pisa, Italy; ³ Division of Cardiothoracic Anesthesia and Intensive Care - Pisa University Hospital, Pittsburgh, USA; ⁴ Section of Transplant Endocrinology and Metabolism - Pisa University Hospital, Pisa, Italy; ⁵ Division of Immunohematology - Pisa University Hospital, Pisa, Italy; ⁶ Division of General Surgery I - Pisa University Hospital, Pisa, Italy

Background: Surgical complications are a major disincentive to pancreas transplantation, despite theundisputed benefits of restored insulin independence. The da Vinci surgicalsystem, a computer assisted electromechanical device, provides the uniqueopportunity to test whether laparoscopy can reduce the morbidity of pancreastransplantation.

Methods: Pancreas transplantation was performed by robot assisted laparoscopyin three patients. The first patient received a pancreas after kidneytransplant, the second a simultaneous pancreas kidney transplantation, and thethird a pancreas transplant alone. Operations were carried out through an 11 mmoptic port, two 8 mm operative ports, and a 7 cm midline incision. The latterwas used to introduce the grafts, handle vascular crossclamping, and createexocrine drainage into the jejunum.

Results: The two solitary pancreas transplants lasted 3 and 5hrs, respectively, the simultaenous pancreas kidney transplantation lasted 8 hrs.Mean warm ischemia time of the pancreas graft was 34 minutes. All pancreata functioned immediately,making their recipients insulin-independent. The kidney graft, revascularizedafter 35 minutes of warm ischemia, also functioned immediately and fully. Nopatient had complications during or after surgery; mean hospital stay was 23 days. After a mean follow-up period of 3.7 months, allrecipients are alive with optimal graft function.

Conclusion: We have shown the feasibility of laparoscopicrobot-assisted solitary pancreas and simultaneous pancreas and kidneytransplantation. If the safety and feasibility of this procedure can be confirmedin larger series, laparoscopic robot assisted pancreas transplantation couldbecome a new option for diabetics needing beta-cell replacement.