Obese patients with type 1 diabetes could safely receive a robotic pancreas transplant

For patients with type 1 diabetes who do not respond well to insulin or who suffer from other serious medical complications related to their disease, the pancreas transplant offers hope for healing. But obese candidates needing a pancreas transplant are often denied the procedure because of poor results, including high rates of incision infections, which are linked to an increased risk of failure and loss of the implanted organ.

But now, UI Health surgeons have demonstrated that obese patients with type 1 diabetes can safely receive a pancreas transplant when the surgery is done in a robotic fashion. Their results are published in the journal Transplant International.

The incidence of obesity in diabetic patients has increased dramatically in recent decades. We have shown that by using robotic surgical techniques, this population can be safely transplanted, meaning that those who have previously been denied can gain access to this procedure that can significantly improve the quality of life. "

Dr. Mario Spaggiari, Assistant Professor of Surgery, UIC College of Medicine, and Lead Author of the article

Diabetic patients who receive a pancreas transplant can often stop taking insulin, but they must continue to receive anti-rejection treatment. Pancreas transplantation to treat type 1 diabetes is not a first-line treatment, it is only practiced in patients who do not respond to insulin injections and who present with diabetes. 39, other serious complications related to their diabetes.

The procedure is currently performed using open surgical techniques where only one long incision is made. The longer the incision, the higher the risk of infection in the wound incision, which can lead to failure of the implanted organ. The robotic transplantation of the pancreas can be performed using a small incision of 5 centimeters, where the new organ will be inserted into the body, and four 1 centimeter incisions for the arms of the surgical robot.

Dr. Enrico Benedetti, Professor and Head of Surgery at the UIC College of Medicine, and his colleagues were the first to use robotic surgery for kidney transplantation in obese patients who were systematically denied because of poor results. Benedetti is co-author of the paper.

Spaggiari, Benedetti, and their colleagues reviewed records of pancreas transplant patients who underwent surgery at UI Health during a four-year period ending in December 2018. Forty-nine patients received pancreas transplants during this period. Seventy-seven percent of patients had type 1 diabetes and 70% had end-stage renal disease requiring dialysis. The average age of the patients was 43 years old.

Patients with a body mbad index greater than or equal to 30 (obesity indicator) underwent surgery using robot-badisted surgical techniques. Ten of the interventions were performed robotically and 39 were performed using traditional open surgical techniques. Eight of the 10 patients who had robot-badisted pancreas transplantation also received a kidney during the procedure. Of the 39 patients who received a pancreas using traditional surgical techniques, 37 received a kidney at the same time.

Compared to traditional open transplants, those who underwent robot-badisted procedure had fewer blood losses and the rates of surgical complications were similar in both groups. The duration of postoperative hospitalization was shorter in patients who underwent the robotic procedure. None of the patients who underwent a robotic pancreas transplant developed wound complications.

"We believe that robotic techniques can also be used to improve outcomes in normal-weight patients who need a pancreas transplant because of the reduced risk of incisional infection, linked to higher risk." loss of the transplanted organ, "said Dr. Enrico Benedetti, a co-author on paper.

Arlys Martinez, 45, of Plainfield, IL, benefited from a combined pancreas and kidney transplant at UI Health in March 2018. Martinez was suffering from type 1 diabetes since she was a girl. Her diabetes eventually led to kidney failure, which she went on to dialysis in January. Because of her reduced ability to exercise and water retention due to dialysis, she was considered overweight to be able to undergo pancreas transplantation in other hospitals.

"I have been told in other hospitals that I should lose a lot of weight to get the pancreas," Martinez said. "I was vaccinated for the kidney, but with the pancreas transplant, they did not want to have surgery because of the large incisions that would be necessary because of my weight, but it was too difficult for me to lose weight at that time because I was so tired and swollen. "

In the end, Martinez joined UI Health and was able to receive a kidney and a pancreas using minimally invasive robotic surgery.

"I'm actually a very good eater, I eat mostly organic and I knew I could lose weight after the transplant, but only UI allowed me to prove it," he said. she said.

Martinez was able to get out of insulin after his transplant and has so far lost more than 20 pounds and continues to lose weight. She can not wait to feel better every day.