Proper completion of this procedure requires some understanding of mouse anatomy in the abdominal cavity. This allows for proper identification of the ampulla of Vater and clamping of the common bile duct. The entire procedure normally takes 1–2 h. It is more efficient to isolate islets from 4–6 mice at the same time, so several samples can be centrifuged together. The time for islet-picking varies, depending on the number of islets and the efficiency of digestion; it may take roughly an hour to pick 250–350 islets from 1 mouse.
In this paper, a number of very realistic images are included: Figure 3 shows the abdominal cavity of the mouse, exposing the common bile duct and hepatic artery. Figure 4 shows the entire length of common bile duct, which appears to be a lighter color, as well as the ampulla of Vater, which is bigger and shinier near the juncture (where the needle will be inserted) between the pancreas and duodenum. A clamp is placed at the common bile duct and hepatic artery bundle close to the liver to block off the flow of collagenase P into liver. Failure to clamp the bile duct correctly or tight enough will result in leakage and incomplete perfusion of the pancreas. Figure 5 shows the needle inserted at the ampulla of Vater into the common bile duct. Once the needle is in the common duct, forceps are used to stabilize the needle to prevent it from puncturing the duct while injecting. Once the injection begins, the pancreas will begin to swell from proximal end to distal end; the splenic region should begin to inflate after about 1 mL of collagenase injection. Backflow into the intestines can lead to an undesirable inflation of the duodenum; this can be remedied by readjusting the placement of the needle (pull it out a little, or reinsert slightly deeper) and by properly stabilizing the needle using forceps. The injection is considered a success if all regions of the pancreas are inflated (duodenal, gastric, and splenic lobes) as shown in Figure 6. Removal of the pancreas should begin from the splenic region. The inflated pancreas is chopped into chunks using fine surgical scissors (Figure 7A). After the 12–13 min digestion and mixing by hand-shaking, the tissue-containing suspension appears more homogeneous (Figure 7B). Subsequently, the islets are purified by the density gradient after centrifugation. Figure 7C shows that an islet suspension layer is formed between HBSS and the density gradient after centrifugation. Good/healthy islets appear as smooth round-shaped; bad/damaged islets show rough edges, and undigested exocrine tissue shows irregular shape and appears more translucent as shown in Figure 8.

Figure 1: Surgical tools.
Curved surgical scissors, cover glass forceps, micro Adson forceps, curved forceps, small surgical scissors, and Schwartz micro serrefines (microvascular clamp) are shown. Please click here to view a larger version of this figure.

Figure 2: Schematic illustration of the protocol.
The most critical steps of this procedure are the clamping of the common bile duct near the liver, and injecting collagenase P via the ampulla of Vater into common bile duct to digest the pancreas. Please click here to view a larger version of this figure.

Figure 3: Location of common bile duct.
Forceps hold up the common bile duct and hepatic artery bundle. Please click here to view a larger version of this figure.

Figure 4: Illustration of common bile duct and ampulla of Vater.
A clamp is placed on the common bile duct and hepatic artery bundle near the liver. The black arrows point to the ampulla of Vater where the needle will be inserted. Please click here to view a larger version of this figure.

Figure 5: Cannulation of common bile duct.
After proper cannulation of the common bile duct, the ampulla of Vater is injected with trypan blue (for demonstration purpose only) to better emphasize the placement of the common bile duct. Please click here to view a larger version of this figure.

Figure 6: Fully inflated pancreas.
The dotted line shows the boundary of the fully perfused pancreas. Forceps hold up the splenic region where islets are most concentrated. Please click here to view a larger version of this figure.

Figure 7: Islet isolation and purification steps.
(A) Mechanically chopped tissue pieces of pancreas before digestion. (B) Digested pancreas—homogeneous tissue suspension of collagenase-perfused pancreas after 13 min of incubation in a shaking water bath at 37 °C, followed by 30 s of mixing by hand. (C) Islet suspension layer is formed between the HBSS and the density gradient after centrifugation. Please click here to view a larger version of this figure.

Figure 8: Representative islet images from Fluorescence Cell-Imager.
(A) Good islets, bad islets and exocrine tissue are seen. (B) A cluster of good islets is shown. (C) Panel shows undigested exocrine tissue attached to a good islet. Good/healthy islets show smooth round edges, indicated by the red letter “G”; bad/damaged islets show irregular shape and rough edges, and are indicated by blue letter “B”. Undigested exocrine tissues appear translucent, often attached to islets, and are indicated by green letter “E”. Please click here to view a larger version of this figure.