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Tuesday, August 19, 2014 | Last updated: 9:52pm

UAMC surgeons perform transplant with use of robots



Robots manufacture cars every single day and roam the surfaces of distant planets, but it’s not as common for mechanical devices to perform complex surgeries.

That’s exactly what they did at the University of Arizona Medical Center this summer.

Three surgeons performed a fully robotic, total pancreatectomy and a simultaneous autologous islet transplant. The surgical team included Dr. Rainer W.G. Gruessner, a professor and chairman of the Department of Surgery; Dr. Horacio Rilo, the director of the cellular transplantation program; and Dr. Carlos Galvani, the director of minimally invasive and robotic surgery.

Although it wasn’t the first surgery of its kind attempted robotically, a total pancreatectomy with a simultaneous islet transplant had never before been completed with the use of a robot.

Fully robotic surgery is the way of the future for curing patients with chronic pancreatitis, said Gruessner.

“It needs to be done in expert hands,” Gruessner said. “This is probably as complex and complicated as it gets in the field of general surgery. Not every surgeon has the patience or skills to do this kind of a procedure.”

Total pancreatectomies require the removal of the entire pancreas — its head, body and tail — as well as the removal of the gall bladder, which is attached to the pancreas. In addition, the pancreas’ close location to other major organs within the body is what makes the procedure so advanced.

“The pancreas, if you look it up in an anatomy book, it’s really in prime real estate in the abdomen,” Gruessner said.

Chronic pancreatitis isn’t exactly a life-threatening disease, said Rilo, but the overwhelming pain caused by the disease severely disrupts daily activities, such as driving a car or working.

“These patients have incredible pain, so they can’t pretty much live with this kind of pain,” Rilo said. “When you ask them what degree of pain they have (on a scale of 1 to 10), they all say 15 or 20.”

That pain led Tami Alveshere, a 39-year-old woman from North Dakota, to participate in the pioneer surgery on July 5. But the three surgeons weren’t the only stars of the show. The da Vinci robotic surgical system assisted in completing the world’s first successful fully robotic total pancreatectomy.

Galvani controlled the machine through a console several feet away from the patient. He saw a three-dimensional view inside the body as the robot operated.

It’s more like computer-assisted surgery than anything else, Galvani said. The robot makes the movements more precise and also eliminates trembling.

“Doing it with the robot facilitated the surgery quite a bit,” he added. “It’s like having your hands inside of the patient, but in a very small size.”

In the past, several surgical teams completed partial pancreatectomies, including one in 2007, which Galvani served on as an assisting surgeon with a team from the University of Illinois, Chicago. In those cases, the surgeons removed only part of the pancreas.

Never before, though, had surgeons accomplished all three phases of a complete pancreatectomy — the removal of the entire pancreas, the reconnection of the gastrointestinal tract and the injection of islets into the liver.

In the autologous islet transplant, 248,000 islets were isolated from the removed pancreas by an automated system that Rilo designed. The cells were then injected into Alveshere’s liver to continue the production of insulin. Without this step, patients are at an increased risk of developing brittle diabetes, Rilo said.

Islet transplants require a high level of expertise by the surgeon because only two percent of the islets in the entire pancreas are usable in cases of chronic pancreatitis, Gruessner said.

“[Rilo’s] only one of a handful of people in the country that can successfully isolate these islets so that we can give them back [to the patient],” Gruessner said.

In open pancreatectomies a large scar is left stretching down the entire stomach to the pelvic bone. Now, with the success of the robotic surgery, the size of the incision can be greatly reduced.

Three small scars remain around Alveshere’s abdomen, and a fourth scar of just a couple inches was left in the bikini region. These smaller cuts help with the cosmetic impact of the procedure and greatly reduce recovery time, Gruessner said.

Alveshere was released from the hospital after 10 days, instead of the typical two weeks for an open pancreatectomy. Shortening hospital stays is one of the goals of the minimally invasive surgery.

“What we’re proud of is a program that offers something that currently no other [center] — and in the future only very few other centers in the country — can offer,” Gruessner said, “and it’s right here at the University of Arizona.”


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