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Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report

RATIONALE: Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its...

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Autores principales: Yeh, Chun Chieh, Spaggiari, Mario, Tzvetanov, Ivo, Oberholzer, José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312984/
https://www.ncbi.nlm.nih.gov/pubmed/28178127
http://dx.doi.org/10.1097/MD.0000000000005847
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author Yeh, Chun Chieh
Spaggiari, Mario
Tzvetanov, Ivo
Oberholzer, José
author_facet Yeh, Chun Chieh
Spaggiari, Mario
Tzvetanov, Ivo
Oberholzer, José
author_sort Yeh, Chun Chieh
collection PubMed
description RATIONALE: Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its value in reducing wound-related complications in obese recipients. PATIENT CONCERNS & DIAGNOSES: We performed the first robotic pancreas after kidney transplantation for a 34-year-old Hispanic type 1 diabetic male with class III obesity (BMI = 41 kg/m(2)). INTERVENTIONS: The pancreas graft was procured and benched in the standard fashion. Methylene blue was used to detect any vascular leaks. The operation was completed via two 12-mm ports (camera, laparoscopic bed-side assistance), two 8-mm ports for robotic arms, and a 7-cm epigastric incision for hand port. The portal vein and arterial Y-graft of the pancreas were anastomosed to the recipient's left external iliac vein and artery, respectively. Duodenum-bladder drainage was performed with a circular stapler. OUTCOMES: Duration of warm and cold ischemia was: 45 minutes and 7 hours, respectively. The patient was discharged uneventfully without wound-related complications. Excellent metabolic control was achieved with hemoglobin A1c lowering from 9% before transplantation to 4.4% on day 120. The patient remained in nondiabetic status in 1-year follow-up. LESSONS: In conclusion, robotic pancreas transplantation is feasible in patients with morbid obesity.
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spelling pubmed-53129842017-02-21 Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report Yeh, Chun Chieh Spaggiari, Mario Tzvetanov, Ivo Oberholzer, José Medicine (Baltimore) 7100 RATIONALE: Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its value in reducing wound-related complications in obese recipients. PATIENT CONCERNS & DIAGNOSES: We performed the first robotic pancreas after kidney transplantation for a 34-year-old Hispanic type 1 diabetic male with class III obesity (BMI = 41 kg/m(2)). INTERVENTIONS: The pancreas graft was procured and benched in the standard fashion. Methylene blue was used to detect any vascular leaks. The operation was completed via two 12-mm ports (camera, laparoscopic bed-side assistance), two 8-mm ports for robotic arms, and a 7-cm epigastric incision for hand port. The portal vein and arterial Y-graft of the pancreas were anastomosed to the recipient's left external iliac vein and artery, respectively. Duodenum-bladder drainage was performed with a circular stapler. OUTCOMES: Duration of warm and cold ischemia was: 45 minutes and 7 hours, respectively. The patient was discharged uneventfully without wound-related complications. Excellent metabolic control was achieved with hemoglobin A1c lowering from 9% before transplantation to 4.4% on day 120. The patient remained in nondiabetic status in 1-year follow-up. LESSONS: In conclusion, robotic pancreas transplantation is feasible in patients with morbid obesity. Wolters Kluwer Health 2017-02-10 /pmc/articles/PMC5312984/ /pubmed/28178127 http://dx.doi.org/10.1097/MD.0000000000005847 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 7100
Yeh, Chun Chieh
Spaggiari, Mario
Tzvetanov, Ivo
Oberholzer, José
Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title_full Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title_fullStr Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title_full_unstemmed Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title_short Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: A case report
title_sort robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity: a case report
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312984/
https://www.ncbi.nlm.nih.gov/pubmed/28178127
http://dx.doi.org/10.1097/MD.0000000000005847
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