Surgical Endoscopy

, Volume 29, Issue 1, pp 176–183 | Cite as

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

  • Amer H. ZureikatEmail author
  • Trang Nguyen
  • Brian A. Boone
  • Martin Wijkstrom
  • Melissa E. Hogg
  • Abhinav Humar
  • Herbert ZehIII



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.


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.


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.


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.


Robotic-assisted surgery Chronic pancreatitis Autologous islet transplantation Pancreatectomy 


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Supplementary material

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  1. 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 18:549–554PubMedCrossRefGoogle Scholar
  2. 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 250:282–287PubMedCrossRefGoogle Scholar
  3. 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 16:1727–1735PubMedCrossRefGoogle Scholar
  4. 4.
    Heidt DG, Burant C, Simeone DM (2007) Total pancreatectomy: indications, operative technique, and postoperative sequelae. J Gastrointest Surg 11:209–216PubMedCrossRefGoogle Scholar
  5. 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 201:680–687PubMedCrossRefGoogle Scholar
  6. 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 568–559PubMedCrossRefGoogle Scholar
  7. 7.
    Panaro F, Testa G, Bogetti D, Sankary H, Helton WS, Benedetti E (2003) Auto-islet transplantation after pancreatectomy. Expert Opin Biol Ther 3:207–214PubMedCrossRefGoogle Scholar
  8. 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–e34PubMedCrossRefGoogle Scholar
  9. 9.
    Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Arch Surg 146:256–261PubMedCrossRefGoogle Scholar
  10. 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 937–939PubMedCentralPubMedCrossRefGoogle Scholar
  11. 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 SurgGoogle Scholar
  12. 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 23:539–544PubMedCrossRefGoogle Scholar
  13. 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 26:2072–2077PubMedCrossRefGoogle Scholar
  14. 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–e78PubMedCrossRefGoogle Scholar
  15. 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):522–527PubMedCrossRefGoogle Scholar
  16. 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 974–965PubMedCrossRefGoogle Scholar
  17. 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 86:1799–1802PubMedCrossRefGoogle Scholar
  18. 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 42:1188–1189PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Amer H. Zureikat
    • 1
    Email author
  • Trang Nguyen
    • 1
  • Brian A. Boone
    • 1
  • Martin Wijkstrom
    • 2
  • Melissa E. Hogg
    • 1
  • Abhinav Humar
    • 2
  • Herbert ZehIII
    • 1
  1. 1.Division of GI Surgical Oncology, Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Division of Transplantation, Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA

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