Laparoscopic approach for human islet transplantation into a defined liver segment in type-1 diabetic patients

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Abstract
Intra-portal islet transplantation is usually performed by cannulation of a mesenteric vein during laparotomy or through percutaneous trans-hepatic cannulation of a portal branch. In this study, we describe a new laparoscopic technique for intra-portal islet transplantation in a defined liver segment, as an alternative to the current procedures. Eighteen type-1 diabetic patients underwent laparoscopic re-permeabilisation of the umbilical vein, followed by catheterization of the left branch of the portal vein. The catheter was guided under fluoroscopic control into a chosen liver segment. It was then secured to the skin or connected to an implantable venous access device. Thereafter, the islet preparation was slowly injected. There was no rise in portal pressure. The median duration of the procedure was 85 min. The procedure was successful in 17 of 18 cases. There were no surgical complications. We conclude that this laparoscopic procedure is a feasible, convenient, and safe alternative method of islet transplantation. Moreover, it allows multiple deliveries of islets into the same liver segment.