University of Minnesota - Department of Surgery
Clinical islet allograft transplantation via mini-laparotomy: the benefit of ultrasound guided transversus abdominis plane (TAP)
Casey Yang2,5, Jacob L Hutchins4, Jean Witson3, Mary C Brandenburg3, Bernhard J Hering3, Josh J Wilhelm3, Melena D Bellin3, Raja Kandaswamy1, David E Sutherland3, James V Harmon Jr1.
1Surgical Critical Care, University of Minnesota, Minneapolis, MN, United States; 2General Surgery, Hennepin County Medical Center, Minneapolis, MN, United States; 3Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, United States; 4Anesthesiology, University of Minnesota, Minneapolis, MN, United States; 5Medical School - Twin Cities, University of Minnesota, Minneapolis, MN, United States
Background: The mini-laparotomy (MLap) technique can be used an alternative approach to percutaneous (Perc) infusion technique as it allows for direct visualization of the islet infusion site. The Mlap technique may reduce blind injuries to the abdominal organs and permit direct surgical control of bleeding. Monitored anesthesia care with conscious sedation (MAC) is often the anesthetic of choice due to the patient ASA status. Due to pain intolerance some patients must be converted to general endotracheal anesthesia (GETA). Pre-operative, ultrasound guided, transversus abdominis plane (TAP) blocks were evaluated for their safety and effectiveness as an adjunct to MAC.
Methods: We performed a retrospective chart review of 49 consecutive adult
patients who underwent allogeneic pancreatic islet cell transplantation at a single center between August 2000 and September 2013.
Results: Thirty-five patients were female and 14 patients were male. The average patient age was 45 years with an age range of 23 to 69 years. A total of 69 islet allograft infusions were performed in these 49 recipients. The anesthesia classification was judged to be ASA class II in 34% of procedures and ASA class III in 66% of the procedures. The MLap technique was used for 51 islet infusions and the Perc technique was used for 18 islet infusions. TAP blocks were performed in 11 of the MLap procedures. The reported blood loss was < 20 ml per procedure for procedures in all groups. The average surgical time for all procedures in all groups was 111 min. The average anesthesia time for all procedures in all groups was 161 min. The operative time was reduced by at least 19 min in the MLap group by including a TAP block or by starting with GETA rather than starting with MAC. In the MLap patients only 1 out of 11 (9%) MAC/TAP procedure was converted to GETA, compared to conversion to GETA in 6 out of 36 (17%) in the MAC only group. One Perc procedure was converted from MAC only to GETA. Conversion to GETA increased operative time by greater than 30 minutes for all procedures in MAC. Conversion to GETA increased by 18 minutes in the TAP group. Serious adverse events were limited to 1 event of non-occlusive portal vein thrombosis and 1 incisional hernia in the MLap group. There was no difference in the hospital length of stay between groups. 81% of patients stayed 2 days. 16% of patients stayed 3 days and 3% of patients stayed longer than three days.
Conclusion: Mini-laparotomy is a safe controlled method for clinical allogeneic islet cell transplantation. The use of pre-operative TAP blocks was associated with a reduced rate of conversion to GETA for patients in this study.
 Mishra, L et al (2013)
 Ismail, S et al (2013)
 Gaber, O et al (2004)
07:00 - 08:00
|Mini-Orals: Clinical Pancreas and Islet Transplantation||Clinical islet allograft transplantation via mini-laparotomy: the benefit of ultrasound guided transversus abdominis plane (TAP)||Room 110|