Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach

Amer H. Zureikat, Trang Nguyen, Brian A. Boone, Martin Wijkstrom, Melissa E. Hogg, Abhinav Humar, Herbert Zeh

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution’s outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery. Methods: This study is a retrospective review of a prospective database of perioperative outcomes of all consecutive robotic TPs at a single institution. This included a single robotic TP with IAT performed on a twenty-year-old patient with chronic pancreatitis. Results: Between 2010 and January 2014, ten robotic TPs were performed (7 males, mean age 58 years), one of which included an IAT. Median body mass index was 28. Indications were intraductal papillary mucinous neoplasms (6), pancreatic adenocarcinoma (1), and chronic pancreatitis (3). The median operative time was 560 min with a median estimated blood loss of 650 ml. One case was converted to laparotomy. Ninety days mortality and Clavien III–IV complication rate were 0 and 20 %, respectively. The average length of stay was 10 ± 3 days, with only 1 readmission within 90 days. The single TP and IAT were completed successfully without conversion, and were achieved without division of the pancreatic neck thereby maintaining vascular inflow to an entire specimen up until extraction. Conclusion: This represents the largest series of robotic TP, demonstrating its safety and feasibility. Additionally, TP and IAT using the technique described above can be recapitulated using the robotic approach.

Original languageEnglish (US)
Pages (from-to)176-183
Number of pages8
JournalSurgical Endoscopy
Volume29
Issue number1
DOIs
StatePublished - Jan 14 2015
Externally publishedYes

Fingerprint

Islets of Langerhans Transplantation
Pancreatectomy
Autologous Transplantation
Cell Transplantation
Robotics
Islets of Langerhans
Chronic Pancreatitis
Warm Ischemia
Operative Time
Pancreatic Neoplasms
Laparotomy
Blood Vessels
Drainage
Pancreas
Length of Stay
Adenocarcinoma
Body Mass Index
Databases
Safety
Mortality

Keywords

  • Autologous islet transplantation
  • Chronic pancreatitis
  • Pancreatectomy
  • Robotic-assisted surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Robotic total pancreatectomy with or without autologous islet cell transplantation : replication of an open technique through a minimal access approach. / Zureikat, Amer H.; Nguyen, Trang; Boone, Brian A.; Wijkstrom, Martin; Hogg, Melissa E.; Humar, Abhinav; Zeh, Herbert.

In: Surgical Endoscopy, Vol. 29, No. 1, 14.01.2015, p. 176-183.

Research output: Contribution to journalArticle

Zureikat, Amer H. ; Nguyen, Trang ; Boone, Brian A. ; Wijkstrom, Martin ; Hogg, Melissa E. ; Humar, Abhinav ; Zeh, Herbert. / Robotic total pancreatectomy with or without autologous islet cell transplantation : replication of an open technique through a minimal access approach. In: Surgical Endoscopy. 2015 ; Vol. 29, No. 1. pp. 176-183.
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AU - Zureikat, Amer H.

AU - Nguyen, Trang

AU - Boone, Brian A.

AU - Wijkstrom, Martin

AU - Hogg, Melissa E.

AU - Humar, Abhinav

AU - Zeh, Herbert

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AB - Background: Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution’s outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery. Methods: This study is a retrospective review of a prospective database of perioperative outcomes of all consecutive robotic TPs at a single institution. This included a single robotic TP with IAT performed on a twenty-year-old patient with chronic pancreatitis. Results: Between 2010 and January 2014, ten robotic TPs were performed (7 males, mean age 58 years), one of which included an IAT. Median body mass index was 28. Indications were intraductal papillary mucinous neoplasms (6), pancreatic adenocarcinoma (1), and chronic pancreatitis (3). The median operative time was 560 min with a median estimated blood loss of 650 ml. One case was converted to laparotomy. Ninety days mortality and Clavien III–IV complication rate were 0 and 20 %, respectively. The average length of stay was 10 ± 3 days, with only 1 readmission within 90 days. The single TP and IAT were completed successfully without conversion, and were achieved without division of the pancreatic neck thereby maintaining vascular inflow to an entire specimen up until extraction. Conclusion: This represents the largest series of robotic TP, demonstrating its safety and feasibility. Additionally, TP and IAT using the technique described above can be recapitulated using the robotic approach.

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