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Published on: January 3, 2020
Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
Chun Chieh Yeh1, Mario Spaggiari, Ivo Tzvetanov
1Division of Transplantation, University of Illinois at Chicago, IL Department of Surgery, China Medical University Hospital School of Medicine, China Medical University, Taichung, Taiwan.
Rationale:
Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its value in reducing wound-related complications in obese recipients.
Patient Concerns & Diagnoses:
We performed the first robotic pancreas after kidney transplantation for a 34-year-old Hispanic type 1 diabetic male with class III obesity (BMI = 41 kg/m).
Interventions:
The pancreas graft was procured and benched in the standard fashion. Methylene blue was used to detect any vascular leaks. 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. Duodenum-bladder drainage was performed with a circular stapler.
Outcomes:
Duration of warm and cold ischemia was: 45 minutes and 7 hours, respectively. The patient was discharged uneventfully without wound-related complications. Excellent metabolic control was achieved with hemoglobin A1c lowering from 9% before transplantation to 4.4% on day 120. The patient remained in nondiabetic status in 1-year follow-up.
Lessons:
In conclusion, robotic pancreas transplantation is feasible in patients with morbid obesity.
