title: Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 418, Pittsburgh, PA, 15232, USA, zureikatah@upmc.edu.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.forename: Trang
authors.initials: T
authors.lastname: Nguyen
authors.forename: Brian A
authors.initials: BA
authors.lastname: Boone
authors.forename: Martin
authors.initials: M
authors.lastname: Wijkstrom
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Herbert
authors.initials: H
authors.lastname: Zeh
mesh_terms: D000328:Adult; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome