Background. Surgical complications are a major disincentive to pancreas transplantation, despite the undisputed benefits of restored insulin independence. The da Vinci surgical system, a computer-assisted electromechanical device, provides the unique opportunity to test whether laparoscopy can reduce the morbidity of pancreas transplantation.
Methods. Pancreas transplantation was performed by robot-assisted laparoscopy in three patients. The first patient received a pancreas after kidney transplant, the second a simultaneous pancreas kidney transplantation, and the third a pancreas transplant alone. Operations were carried out through an 11-mm optic port, two 8-mm operative ports, and a 7-cm midline incision. The latter was used to introduce the grafts, enable vascular cross-clamping, and create exocrine drainage into the jejunum.
Results. The two solitary pancreas transplants required an operating time of 3 and 5 hr, respectively; the simultaneous pancreas kidney transplantation took 8 hr. Mean warm ischemia time of the pancreas graft was 34 min. All pancreatic transplants functioned immediately, and all recipients became insulin independent. The kidney graft, revascularized after 35 min of warm ischemia, also functioned immediately. No patient had complications during or after surgery. At the longer follow-up of 10, 8, and 6 months, respectively, all recipients are alive with normal graft function.
Conclusions. We have shown the feasibility of laparoscopic robot-assisted solitary pancreas and simultaneous pancreas and kidney transplantation. If the safety and feasibility of this procedure can be confirmed by larger series, laparoscopic robot-assisted pancreas transplantation could become a new option for diabetic patients needing beta-cell replacement.
1Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy.
2Division of General and Vascular Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy.
3Division of Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy.
4Division of Transplant Endocrinology and Metabolism, Pisa University Hospital, Pisa, Italy.
5Division of Immunohaemathology, Pisa University Hospital, Pisa, Italy.
6Division of General Surgery 1, Pisa University Hospital, Pisa, Italy.
The authors declare no funding or conflicts of interest.
Address correspondence to: Ugo Boggi, M.D., F.E.B.S., Department of Surgery, University of Pisa, Renal and Pancreas Transplant Programs, Pisa University Hospital, U.O. di Chirurgia Generale e Trapianti, Azienda Ospedaliera Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy. E-mail: email@example.com
U.B. conceived the operation, wrote the surgical protocol, coordinated the multidisciplinary team, was the first surgeon in two donor procedures and in all recipient operations, and wrote the manuscript with assistance from all other authors. S.S. assisted all recipient operations and was the donor surgeon in one operation. F.V. provided postoperative care. S.D.I. recorded intra- and postoperative data. G.A. conceived anesthesia protocol and delivered anesthesia to recipients. G.C. delivered anesthesia to recipients. F.G. coordinated the anesthesia team and the immediate postoperative care team. P.M. cared for recipient selection and posttransplant metabolic follow-up. D.F. cared for immunosuppression and posttransplant immunologic follow-up. F.M. reviewed the surgical protocol.
Received 19 August 2011. Revision requested 1 September 2011.
Accepted 20 September 2011.