261-LB: Robotic Pancreas Kidney Transplantation for Type 1 Diabetic Patient with End-Stage Renal Disease: First Year Experience in Single Institute

Background: Simultaneous pancreas kidney transplantation for type 1 diabetic patients with ESRD is a highly successful, but also very invasive surgery. Robotic assistance facilitates a minimally invasiveness approach to this technically intricate surgery. The present study aims to evaluate the feasibility and outcomes of the first year`s experience in robotic pancreas kidney transplantation (RPKT) for type 1 diabetic patients with ESRD.

Patients and Methods: From October 2017 to October 2018, we enrolled consecutive cases of RPKT at the University of Virginia. Operative and clinical features including graft and patient survivals were retrospectively analyzed. The organs were introduced via 6 cm Pfannenstil incision.

Results: Six patients (3 male/3 female) successfully underwent RPKT. Median age was 32 years old (range: 30-46years). Median pre-transplant body mass index (BMI) was 25.5 mg/kg² (Range: 20.6-33.4 mg/kg²). Operative time and estimated blood loss were 593 min (473-733) and 300cc (150-400), respectively. Total cold and warm ischemic time were 436 min (242-585) for pancreas/725min (403-835) for kidney and 43 min (34-60) for pancreas/56min (44-69) for kidney, respectively. We created 5 enteric and 1 bladder drainage for transplant pancreas. There were no conversions to open. No major complications during surgery were observed. We reported one case of delayed graft function of kidney and two cases of rejection with complete recovery. We found one patient with a minor trocar wound dehiscence and revision of ureterocystostomy for stricture. There was one pancreas graft loss at postoperative 7 days due to graft vein thrombosis. No patient death was noted.

Conclusion: RPKT for type 1 diabetic patients with ESRD appears to be a safe and effective surgical procedure with potential advantages of wound complication, quality of vascular anastomosis, and shorter recovery with minimal incision compared to conventional open surgery.