Introduction

Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound and surgical related complications. Robotic surgery has never been applied to pancreas transplantation in obese recipients despite robotic kidney transplantation has proven its value in reducing wound-related complications in these recipients.

Material and methods

From October 2015 to July 2016, five morbidly obese patients with diabetes underwent laparoscopic robotic-assisted pancreas transplantation at the University of Illinois at Chicago. The pancreas graft was procured and benched in the standard fashion. The operation was completed via two 12-mm ports (camera, laparoscopic bed-side assistance), two 8-mm ports for robotic arms, and a 7-cm epigastric incision for hand port. The portal vein and arterial Y-graft of the pancreas were anastomosed to the recipient's left external iliac vein and artery, respectively. Exocrine pancreas drainage was performed via the bladder in three cases and through the jejunum in the remaining two.

Results

Three recipients had type 1 diabetes, the remaining two had insulin dependent type 2 diabetes. All recipients were obese patients, with an average BMI of 34±4.63 kg/m². Mean duration of cold and warm ischemia times were 11±4.5 hours and 43±7 minutes, respectively. The averages of the estimated blood loss was of 180±27.4 mL, of the operative time was of 433.4±125 minutes and of the hospitalization was 7.4±1.7 days. The post-operative period was uneventful for all patients. No surgical site infections were observed during the hospital course and the subsequent follow ups. Excellent metabolic control was achieved in all cases at the time of discharge and at a mean 16±5.6 month follow up, patients were not on insulin treatment and the average hemoglobin A1c was 4.92±0.5 %.

Conclusions

Robotic-assisted pancreas transplantation is a successful novel approach that minimizes surgical and wound related complications and can offer a valuable strategy for Type II-diabetic obese patients with suppressed level of c-peptide.

CITATION INFORMATION: Spaggiari M., Di Bella C., Di Cocco P., Gheza F., Benedetti E., Tzvetanov I., Oberholzer J. Robotic Pancreas Transplantation in Obese Recipients: Preliminary Results Am J Transplant. 2017;17 (suppl 3).

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