Pancreas procurement technique. Lessons learned from an initial experience.
OBJECTIVE
Multiorgan procurement requires good anatomical knowledge and perfect synchronization between surgeons to ensure adequate dissection of visceral vessels. The aim of this article is to assess a technique for pancreas procurement in a multiorgan donor.


METHODS
starting our program of pancreas transplantation we adopted a technique for "in situ" simultaneous recovery of pancreas, liver and small bowel when indicated. We performed 3/4 of the dissection with an intact donor circulation of the organs so taht the cold ischemia time was kept to a minimum. The technique was used in 18 multiorgan cadaveric donors during a period of 74 months. Seventeen out of 18 pancreatic grafts were transplanted simultaneously with a kidney. The small intestine was transplanted in one case and the liver in 18 cases.


RESULTS
None of the transplanted pancreases sustained serious ischemic or vascular injuries. One pancreatic graft was discarded due to iatrogenic vascular injury during the procurement. Vascular surgical complications included 1 portal thrombosis, 1 iliac graft thrombosis and 1 iliac graft pseudoaneurysm. Pancreas allograft removal was necessary in 4 patients. All the retrived liver and the small intestine were successfully transplanted elsewhere.


CONCLUSIONS
All except one of the pancreatic grafts retrived with this technique were of excellent quality. A perfect coordination between the different surgical equipes is mandatory in order to limit the risk of vascular injury, particulary in the presence of anatomical variations.
Dalle Valle
Raffaele
R
Department of Surgical Science, University of Parma, Parma, Italy. r.dalval@unipr.it
Capocasale
Enzo
E
Mazzoni
Maria Patrizia
MP
Busi
Nicola
N
Sianesi
Mario
M
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D050377:Cold Ischemia; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D004210:Dissection / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007421:Intestine, Small / Q000601:surgery / Q000637:transplantation; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D009392:Nephrectomy; D009926:Organ Preservation; D010179:Pancreas / Q000098:blood supply; D016035:Pancreas Transplantation / Q000379:methods / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000379:methods*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D016896:Treatment Outcome