*Purpose: Pancreas transplantation has evolved to include select overweight and obese diabetes mellitus (DM) patients. A robotic approach can be utilized to treat obese transplant candidates with the aim of reducing surgical complications and increasing access to pancreas transplantation.

*Methods: From October 2015 to July 2018, ten patients underwent robotic-assisted pancreas transplantation with eight being simultaneous kidney pancreas transplants. Intraoperative, patient and donor information were evaluated.

*Results: The average BMI of the recipients was 33.7±5.2 kg/m² at the time of transplant. Patient and donor demographics are summarized in Table 1. Mean duration of operation for SPK was 8.3±0.8 hours while the median cold (CIT) and warm ischemia (WIT) times for the pancreas transplant were 8 (6.4-9.6) hours and 49 (42.8-55.3) minutes, respectively. Similarly, median CIT and WIT for the kidney transplants were 12 (10.8-12.3) hours and 45 (38-65.8) minutes. Seven patients were enterically drained. The median estimated blood loss was of 150 mL and median length of stay of 7 days. Median length of follow up is 15 (8-27) months with 5 patients having greater than a year of follow up. At 1 month follow up the average creatinine and glucose levels were 1.34±0.4mg/dL and 101±15.7, respectively, with all patient achieving sustained euglycemia with no insulin requirement. At time of last follow up, the average creatinine and glucose levels were 1.44±0.5mg/dL and 99±29.2, respectively.

*Conclusions: Robotic approach to pancreas transplantation in patients with elevated BMI appears to be safe and provides acceptable surgical outcomes and sustained graft function outcome.

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