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.
Similar content being viewed by others
References
Bhayani NH, Miller JL, Ortenzi G, Kaifi JT, Kimchi ET, Staveley-O’Carroll KF, Gusani NJ (2014) Perioperative outcomes of pancreaticoduodenectomy compared to total pancreatectomy for neoplasia. J Gastrointest Surg 18:549–554
Reddy S, Wolfgang CL, Cameron JL, Eckhauser F, Choti MA, Schulick RD, Edil BH, Pawlik TM (2009) Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg 250:282–287
Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM (2012) Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg 16:1727–1735
Heidt DG, Burant C, Simeone DM (2007) Total pancreatectomy: indications, operative technique, and postoperative sequelae. J Gastrointest Surg 11:209–216
Ahmad SA, Lowy AM, Wray CJ, D’Alessio D, Choe KA, James LE, Gelrud A, Matthews JB, Rilo HL (2005) Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg 201:680–687
Gruessner RW, Sutherland DE, Dunn DL, Najarian JS, Jie T, Hering BJ, Gruessner AC (2004) Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis. J Am Coll Surg 198:559–567 discussion 568–559
Panaro F, Testa G, Bogetti D, Sankary H, Helton WS, Benedetti E (2003) Auto-islet transplantation after pancreatectomy. Expert Opin Biol Ther 3:207–214
Desai CS, Stephenson DA, Khan KM, Jie T, Gruessner AC, Rilo HL, Gruessner RW (2011) Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg 213:e29–e34
Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Arch Surg 146:256–261
DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937 discussion 937–939
Janot MS, Belyaev O, Kersting S, Chromik AM, Seelig MH, Sulberg D, Mittelkotter U, Uhl WH (2010) Indications and early outcomes for total pancreatectomy at a high-volume pancreas center. HPB Surg
Dokmak S, Aussilhou B, Sauvanet A, Ruszniewski P, Levy P, Belghiti J (2013) Hand-assisted laparoscopic total pancreatectomy: a report of two cases. J Laparoendosc Adv Surg Tech A 23:539–544
Choi SH, Hwang HK, Kang CM, Yoon CI, Lee WJ (2012) Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc 26:2072–2077
Galvani CA, Rodriguez Rilo H, Samame J, Porubsky M, Rana A, Gruessner RW (2014) Fully robotic-assisted technique for total pancreatectomy with an autologous islet transplant in chronic pancreatitis patients: results of a first series. J Am Coll Surg 218:e73–e78
Bhayani NH, Enomoto LM, Miller JL, Ortenzi G, Kaifi JT, Kimchi ET, Staveley-O’Carroll KF, Gusani NJ (2013) Morbidity of total pancreatectomy with islet cell auto-transplantation compared to total pancreatectomy alone. HPB 16(6):522–527
Muller MW, Friess H, Kleeff J, Dahmen R, Wagner M, Hinz U, Breisch-Girbig D, Ceyhan GO, Buchler MW (2007) Is there still a role for total pancreatectomy? Ann Surg 246:966–974 discussion 974–965
Sutherland DE, Gruessner AC, Carlson AM, Blondet JJ, Balamurugan AN, Reigstad KF, Beilman GJ, Bellin MD, Hering BJ (2008) Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation 86:1799–1802
Galvani CA, Rilo HR, Samame J, Gruessner RW (2013) First fully robotic-assisted total pancreatectomy combined with islet autotransplant for the treatment of chronic pancreatitis: a case report. Pancreas 42:1188–1189
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MOV 324087 kb)
Rights and permissions
About this article
Cite this article
Zureikat, A.H., Nguyen, T., Boone, B.A. et al. Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach. Surg Endosc 29, 176–183 (2015). https://doi.org/10.1007/s00464-014-3656-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3656-x