Robotic pancreas transplant offers hope for obese patients with Type 1 diabetes

Robotic pancreas transplant offers hope for obese patients with Type 1 diabetes
Left to right: Dr. Mario Spaggiari, Arlys Martinez and Dr. Enrico Benedetti. Credit: Fatemi Hossein.

For patients with Type 1 diabetes who don't respond well to insulin or have other serious medical complications caused by their disease, pancreas transplantation offers hope for a cure. But obese candidates who need a pancreas transplant often are denied the procedure because of poor outcomes, including high rates of incision infections, which are linked to an increased risk for failure and loss of the implanted organ.

But now, surgeons at UI Health have demonstrated that obese patients with Type 1 diabetes can safely receive a when the surgery is performed robotically. Their findings are published in the journal Transplant International.

"The incidence of obesity among has risen dramatically over the past decades," said Dr. Mario Spaggiari, assistant professor of surgery in the UIC College of Medicine, and lead author of the paper. "We have shown that by using robotic surgical techniques, this population can be safely transplanted, meaning that those who would have previously been denied can have access to this procedure that can vastly improve quality of life."

Patients with diabetes who receive a transplant often can stop taking insulin, but they must stay on an anti-rejection drug regimen. Pancreas transplantation to treat Type 1 diabetes is not a first-line treatment for the disease and is only performed in patients who don't respond to insulin injections, and who have other severe complications that arise from their diabetes.

The procedure currently is performed using open surgical techniques where a single, long incision is made. The longer the incision, the higher the risk for an infection in the healing incision, which can lead to failure of the implanted organ. Robotic pancreas transplantation can be performed using a small, 5-centimeter incision, where the new organ will be slipped into the body, and four, 1-centimeter incisions for the surgical robot's arms.

Dr. Enrico Benedetti, professor and head of surgery at the UIC College of Medicine, and his colleagues pioneered the use of robotic surgery for in who were routinely denied the procedure because of poor outcomes. Benedetti is a co-author on the paper.

Spaggiari, Benedetti and their colleagues looked back at the records of pancreas transplant patients who had procedures that took place at UI Health over a four-year period ending in December 2018. Forty-nine patients received a pancreas transplant over that time. Seventy-seven percent of the 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 body mass indices at or above 30 (indicative of obesity) underwent procedures using robotically assisted surgical techniques. Ten of the procedures were performed robotically, and 39 were performed using traditional, open surgical techniques. Eight of the 10 patients who underwent robotically assisted 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 with patients who underwent traditional open transplantation, those who underwent the robotically assisted procedure had less blood loss, and surgical complication rates were similar in both groups. The length of post-operative hospitalization was shorter for patients who underwent the robotic procedure. None of the patients who underwent robotic pancreas transplant developed any wound complications.

"We think that robotic techniques can also be used to improve outcomes for normal weight who need pancreas transplants because of the reduced risk for incision infection, which is linked to a higher risk of losing the transplanted organ," said Dr. Enrico Benedetti, a co-author on the paper.

Arlys Martinez, 45, of Plainfield, Illinois, was a recipient of a combined pancreas and kidney transplant at UI Health in March 2018. Martinez suffered from Type 1 diabetes since she was a girl, and her diabetes eventually led to kidney failure, which required that she go on dialysis in January. Due to her restricted ability to exercise and water retention caused by the dialysis, she was considered too overweight to undergo pancreas transplantation at other hospitals.

"I was told at other hospitals that I would have to lose a significant amount of weight in order to get the pancreas," Martinez said. "I was cleared for the kidney, but with the pancreas transplant, they didn't want to do the surgery because of the large incisions that would be required because of my weight. But it was too hard for me to lose weight at that time because I was so tired and bloated."

Ultimately, Martinez came to UI Health and was able to receive both a kidney and a pancreas using minimally invasive robotic surgery.

"I am actually a really good eater—I eat mostly organic, and I knew I could lose the weight after the transplant, but only UI Health gave me the chance to prove that," she said.

Martinez was able to go off insulin after her , and has so far lost more than 20 pounds, and continues to lose weight. She is looking forward to feeling better and better every day.


Explore further

Patients who lose significant weight before a transplant are at higher risk of dying

More information: Mario Spaggiari et al, The Utility of Robotic Assisted Pancreas Transplants, Transplant International (2019). DOI: 10.1111/tri.13477
Citation: Robotic pancreas transplant offers hope for obese patients with Type 1 diabetes (2019, July 10) retrieved 23 July 2019 from https://medicalxpress.com/news/2019-07-robotic-pancreas-transplant-obese-patients.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
 shares

Feedback to editors

User comments

Jul 15, 2019

I have been suffering from HIV and Genital Herpes for the past 3 years and 8 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr TAKUTA on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i took according to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Herpes. My heart is so filled with joy. If you are suffering from Herpes or any other disease you can contact Dr TAKUTA today on this Email address: takutaspellalter@gmail.com or WhatsApp him on this Tell.Number +27788634102....

Dr.TAKUTA also cures:
1. HEPATITIS A,B,C
2. HERPES 1/2
3.DIABETES
4.STROKE.
5.STDS and STI
6. MARRIAGE COUNSELLING
7.LOVE SPELL CASTING
8.JOB PROMOTION SPELLS
9.MARITAL PROBLEM
10.MAGIC MONEY SPELLS

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more