title: Laparoscopic robot-assisted pancreas transplantation:  first world experience.
abstract: BACKGROUND
  Surgical complications are a major disincentive to pancreas transplantation, despite the undisputed benefits of restored insulin independence. The da Vinci surgical system, a computer-assisted electromechanical device, provides the unique opportunity to test whether laparoscopy can reduce the morbidity of pancreas transplantation.
  
  
  METHODS
  Pancreas transplantation was performed by robot-assisted laparoscopy in three patients. The first patient received a pancreas after kidney transplant, the second a simultaneous pancreas kidney transplantation, and the third a pancreas transplant alone. Operations were carried out through an 11-mm optic port, two 8-mm operative ports, and a 7-cm midline incision. The latter was used to introduce the grafts, enable vascular cross-clamping, and create exocrine drainage into the jejunum.
  
  
  RESULTS
  The two solitary pancreas transplants required an operating time of 3 and 5 hr, respectively; the simultaneous pancreas kidney transplantation took 8 hr. Mean warm ischemia time of the pancreas graft was 34 min. All pancreatic transplants functioned immediately, and all recipients became insulin independent. The kidney graft, revascularized after 35 min of warm ischemia, also functioned immediately. No patient had complications during or after surgery. At the longer follow-up of 10, 8, and 6 months, respectively, all recipients are alive with normal graft function.
  
  
  CONCLUSIONS
  We have shown the feasibility of laparoscopic robot-assisted solitary pancreas and simultaneous pancreas and kidney transplantation. If the safety and feasibility of this procedure can be confirmed by larger series, laparoscopic robot-assisted pancreas transplantation could become a new option for diabetic patients needing beta-cell replacement.
authors.affiliation: Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy. u.boggi@med.unipi.it
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Stefano
authors.initials: S
authors.lastname: Signori
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Simone
authors.initials: S
authors.lastname: D'Imporzano
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.forename: Giovanni
authors.initials: G
authors.lastname: Consani
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Piero
authors.initials: P
authors.lastname: Marchetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Focosi
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000502:physiology; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult