First-Ever Robotic Pancreatectomy Combined with Auto-Islet Transplant

Surgeons at the University of Illinois Medical Center at Chicago performed a groundbreaking robotic pancreatectomy in a 39-year-old man to relieve him of debilitating pain. They also performed an autologous islet cell transplant to prevent him from developing surgical diabetes.

Terry Near, of Rock Falls, Ill., is the first patient in the world to undergo a pancreatectomy, or removal of the pancreas, using robotic surgery, combined with an autologous islet cell transplant, according Dr. Pier Cristoforo Giulianotti, Lloyd M. Nyhus Professor of Surgery and chief of the division of minimally invasive, general and robotic surgery at UIC. Near was diagnosed with pancreatitis in 2002 and underwent surgery to drain a pancreatic pseudocyst. Since then, his chronic familial pancreatitis has caused sporadic severe bouts of pain and left him unable to continue his work as a prison guard. During surgery, physicians inserted the laparoscope and robotic arms of the da Vinci surgical system through five small incisions in the patient’s abdomen. The pancreas was then removed through a two-inch incision. “This surgery is unique because it combines two very sophisticated and complicated procedures,” Giulianotti said. “Using the robot allowed us to delicately manipulate the pancreas without injuring the islets cells. This would have been barely feasible with traditional minimally invasive surgery. It also allowed us to carefully preserve the spleen, which is usually removed during a pancreatectomy.” Robotic-assisted minimally invasive surgery provides a level of dexterity not possible with traditional laparoscopic instruments. While seated at a surgical console, physicians view the operating field in 3-D and use computerized controls to precisely manipulate instruments inside the patient, with 360-degree range of motion. Removing a chronically inflamed pancreas in a patient with chronic pancreatitis is a very difficult operation, even with a large incision, according to Dr. Jose Oberholzer, associate professor of surgery and bioengineering at UIC and director of cell and pancreas transplantation at the medical centre. After removing 60 percent of Near’s pancreas, physicians prepared the gland in the hospital’s state-of-the-art lab designed to isolate the insulin-producing cells of the pancreas, called islets. The islet cells were then taken back to the operating room, where they were injected through a catheter into a vein in the patient’s liver. Without a pancreas to produce insulin, Near would need insulin for the rest of his life. By transplanting the patient’s own islets cells, there is no risk of rejection as in other organ transplants, and the cells lodge in the liver and make insulin. Compared to his first open pancreatic surgery, Near says “recovery is definitely a lot faster.” Near was discharged from the hospital three days after the May 21 surgery. Chronic pancreatitis, an inflammation or scarring of the pancreas, is a life-threatening condition that destroys the pancreas and often results in severe abdominal pain, weight loss, fever, nausea, vomiting and, in some cases, cancer. Gallstones, a combination of environmental and hereditary factors or heavy alcohol use can cause the disease. Sometimes the cause is unknown. In addition to Giulianotti and Oberholzer, UIC surgeons on the team included Dr. Enrico Benedetti, chief of transplantation and interim head of surgery, and Dr. Carlos Galvani, assistant professor of surgery. The surgical team also included Rita Hamilton from Intuitive Surgery, manufacturer of the da Vinci Surgical System. (Source: University of Illinois at Chicago : June 2007)