In late February, Surgeon Greg Beilman, MD, scrubbed in for a surgery that in many ways was both routine and remarkable.
His patient: A hard-working father and husband whose ability to provide for his family was in jeopardy because of the life-altering pain caused by chronic pancreatitis.
The procedure: A total pancreatectomy and islet auto-transplant (TP-IAT), a complex surgery involving the full or partial removal of several organs in the body, including complete removal of the pancreas.
The surgery was routine because it was the 600th such operation University of Minnesota Health doctors and care teams have performed since we pioneered the procedure in 1977. Remarkable because it offers patients with chronic pancreatitis a new chance at a pain-free life.
The University of Minnesota Health TP-IAT program is the largest and most experienced program of its kind in the world. Still, the 600th surgery is milestone—for both our healthcare providers and patients.
“They’re relieved when they find us, because we listen to them,” said Beilman, the surgical director of the adult TP-IAT program. “We say ‘You’re not alone. There are other people with this problem and we understand what your struggles.’”
Many adult patients have suffered through the pain for years or decades. Most have seen a battery of other specialists and have put their hope in other treatments or procedures, only to be disappointed when those options fail.
Full removal of the pancreas offers relief from the pain, but would ordinarily trigger the immediate onset of diabetes. To prevent that from occurring, our care teams isolate insulin-producing islet cells in the pancreas and transplant them to the patient’s liver, where they continue to function.
The procedure was first developed in the 1970s by University of Minnesota Surgeon David Sutherland, MD, PhD, as an off-shoot of Sutherland’s research in diabetes treatment techniques, Beilman said. Physicians later realized the value of the procedure for treating chronic pancreatitis. M Health providers performed the procedure sporadically in the 1990s, but in the early 2000s, the procedure picked up steam with the improvement and standardization of surgical techniques and islet cell harvesting procedures, Beilman said.
In 2014, University of Minnesota Health care teams performed 50 TP-IAT procedures, including 15 pediatric procedures. Of all 600 surgeries we’ve performed, roughly one-sixth of them were performed on children between the ages of 3 and 18.
“600 is a huge number for such a relatively rare procedure,” said Pediatric Endocrinologist Melena Bellin, MD, who cares for pediatric and adult TP-IAT patients. “Our outcomes are better because we have a higher volume, which means we have more experience and are better equipped to provide high-quality care.”
In recent years, those innovations have led to a decrease from 22 days to nine days in the average hospital stay for our TP-IAT patients, and a 10 percent decrease in surgical site infection risk, Beilman said.
“Our TP-IAT patients spend less time in the hospital and recover faster,” Beiman said. “They have fewer complications than others over their lifespan.”
Our surgeons are constantly honing their techniques and have developed a minimally invasive surgical approach that reduces the size of the incision by 50 percent, which makes for easier healing following the surgery, Bellin said.
We also have continued to refine our techniques to boost the number of islet cells that can be isolated from the pancreas and re-inserted into the patient.
Our islet lab at the Schulze Diabetes Institute has been in operation since 1977, making it the oldest continually running islet lab in the United States. Three of our lab technicians at the lab are among the top 10 most experienced islet cell technicians in the world, having each conducted more than 300 islet cell isolations, Islet Lab Director Josh Wilhelm said.
Research and innovation are important, but so are the multi-disciplinary care teams that assist each patient in our program. TP-IAT patients work with psychologists, pain medicine specialists, pharmacists, dietitians, gastroenterologists, endocrinologists and surgeons during their care before and after surgery. All of these specialists meet once a week to discuss care options and coordinate their services for individuals in our program.
“We bring excellent minds together who have decades of experience treating these patients, and they don’t have that at other TP-IAT centers,” Beilman said.
Ultimately, though, Bellin and Beilman say they define success by their ability to return a patient to “normal life.”
“The reason that we do this is primarily to restore their quality of life,” Bellin said. “We want adults and children to be able to function and live normally without pain.”