Abstract
ObjectiveWe introduce the trans-umbilical single-site plus one robotic-assisted surgery for the treatment of pediatric choledochal cyst. Compare the intraoperative and postoperative outcomes between the new method and traditional laparoscopy-assisted procedure.MethodWe retrospectively analyzed the clinical data of 51 children diagnosed with choledochal cysts and received surgery from June 2019 to December 2020 at our department. About 24 patients who underwent the robot-assisted procedure were selected as the R group, and 27 patients who underwent the laparoscope-assisted procedure were selected as the L group. We compare the intraoperative and postoperative outcomes between the two groups.ResultNo significant differences were found in demographic information between the two groups (P > 0.05). The median total operative time, median port/trocar installation time, and median wound suture time of the R group were a little longer than the L group (217.63 ± 5.90 vs. 199.37 ± 5.13 min; 30.71 ± 3.18 vs. 6.11 ± 1.15 min; 30.79 ± 1.82 vs. 20.40 ± 3.12 min, respectively; P < 0.001). However, the R group had shorter choledochal cyst excision time and mean hepaticojejunostomy anastomosis time than the L group (52.04 ± 2.74 vs. 59.26 ± 3.23 min; 52.42 ± 2.72 vs. 60.63 ± 3.30 min, respectively, P < 0.001). The mean extracorporeal Roux-y jejunojejunostomy time of two groups has no remarkable difference (P > 0.05). The R group also had less mean volume of blood loss (7.04 ± 1.16 vs. 29.04 ± 18.21 mL; P < 0.001). The R group had a shorter indwelling time of gastric tube, anal exhaust time, water feeding time, solids feeding time, and hospital stay time than the L group (P < 0.05). The R group had a lower early complication rate than the L group (4.2 vs. 29.63%; P = 0.026). No statistical differences were identified between the two groups in late or any single complication (0.00 vs. 11.11%; P > 0.05).ConclusionsA resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy can be performed much more precisely by single-site plus one robotic-assisted surgery. Patients can achieve rapid recovery, and the umbilical incision is more concealed and beautiful. Combing the experience of single-site surgery with robot-assisted surgery, the operators can implement the technique in children safely and feasibly.
Highlights
A choledochal cyst is a congenital anomaly of the biliary system, characterized by the dilatation of the intrahepatic or extrahepatic bile ducts and often associated with pancreaticobiliary maljunction
About 24 patients who underwent the robot-assisted procedure were selected as the R group, and 27 patients who underwent the laparoscopy-assisted procedure were selected as the L group
A child’s small abdominal cavity and limited operating space hardly match the large size of the machine, which impedes its application in the field of pediatric surgery to some extent
Summary
A choledochal cyst is a congenital anomaly of the biliary system, characterized by the dilatation of the intrahepatic or extrahepatic bile ducts and often associated with pancreaticobiliary maljunction. It is much more common in Asian countries than in western countries, with an incidence of 1,000 cases per million people (1). In 2020, after importing the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), we combined the robot system with a quadruple-channel puncture device to invent trans-umbilical single-site plus one robotic-assisted choledochal cyst excision and hepaticojejunostomy. The new modified technique makes the procedure more sophisticated through a robot system, but it retains the minimally invasive appearance of trans-umbilical single-site surgery. We conducted a retrospective study to investigate the safety and effectiveness of laparoscopic procedures and trans-umbilical single-site plus 1 robotic- assisted procedure in pediatric choledochal cyst excisions
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