Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation

Article View

Abstract
The Review of Diabetic Studies,2011,8,1,28-34.
Published:May 2011
Type:Review Article
Authors:
Author(s) affiliations:

Ugo Boggi1, Stefano Signori1, Fabio Vistoli1, Simone D’Imporzano1, Gabriella Amorese2, Giovanni Consani2, Nelide De Lio1, Vittorio Perrone1, Chiara Croce1, Piero Marchetti3, Diego Cantarovich4, and Franco Mosca5

1Division of General and Transplant Surgery, 2Division of General and Vascular Anesthesia and Intensive Care, 3Section of Transplant Endocrinology and Metabolism, 4Division of Nephrology, 5Division of General Surgery 1, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.

Abstract:

Pancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author’s experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community.