Skip to main content

Advertisement

Log in

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

  • Video
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Heidt DG, Burant C, Simeone DM (2007) Total pancreatectomy: indications, operative technique, and postoperative sequelae. J Gastrointest Surg 11:209–216

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Arch Surg 146:256–261

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed Central  PubMed  Google Scholar 

  11. 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

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amer H. Zureikat.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MOV 324087 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3656-x

Keywords

Navigation