Total Excision Of Cyst Research Articles

Coexistence of Thyroglossal Cyst and Thyroid Disease in Adults: Surgical Outcomes From A Single Center.

Thyroglossal cysts (TGCs) usually present during childhood and before the age of 30, however, they can also be seen in adults, even in advanced age. Nodular thyroid disease is also common in adults. In the literature, there is an ongoing debate regarding the differences in clinical presentation, gender, and postoperative recurrence of TGC between children and adults. In this study, we aimed to process the data of adult patients who underwent surgery for TGC in our clinic, along with the data on concurrent thyroid disease and thyroid surgery. The data of patients over 18 years old who were operated on for TGC at the General Surgery Clinic of Sisli Hamidiye Etfal Training and Research Hospital between 2018 and 2024 were retrospectively evaluated. A total of 16 patients with a mean age of 43.94±12.98 (21-67) years, were included in the study (11 F/5 M). The diagnosis of TGC was made in 12 patients (75%) by ultrasonography (USG), in 1 patient (6.25%) by computed tomography, in 1 patient (6.25%) by magnetic resonance imaging (MRI), and in 2 patients (12.5%) incidentally intraoperatively. 13 patients (81.25%) underwent the Sistrunk procedure, and 3 patients (18.75%) underwent cyst excision. Among the 16 TGC patients, papillary thyroid cancer in the cyst was detected in one patient (6.25%) preoperatively. During preoperative evaluation, nodular thyroid disease was found in 12 patients (75%). Of these, papillary thyroid cancer was detected in 3 patients (18.75%) preoperatively. Of the TGC group, 3 (18.75%) underwent thyroidectomy for thyroid malignancy, and five (31.25%) underwent additional thyroid surgery for nodular thyroid disease. The patients were followed for a mean of 22.63±18.32 months (3-67 months), and no recurrence of TGC was observed during the follow-up period. In patients with TGC, thyroid diseases and the requirement for thyroidectomy due to benign or malignant thyroid disease are not uncommon. Patients with TGC should be evaluated for thyroid disease before surgical treatment. While the Sistrunk procedure is the standard surgical technique in the treatment of TGC, in adults, if the cyst terminates below the hyoid bone, total cyst excision without removing the central portion of the hyoid bone may be sufficient.

Perspective: Timely diagnosis and repair of intraoperative thoracic/lumbar cerebrospinal fluid (CSF) leaks.

Our review of 12 articles for this perspective showed the frequency of intraoperative thoracic and/or lumbar CSF fistulas/dural tears (DT) ranged from 2.6% - 8% for primary surgical procedures. Delayed postoperative CSF leak/DT were also diagnosed in 0.83% (17/2052 patients) to 14.3% (2/14 patients) of patients undergoing thoracic and/or lumbar procedures. Further, the rate of recurrent postoperative CSF leaks/DT varied from 13.3% (2/15 patients) to 33.3% (4/12 patients). Intraoperative, postoperative delayed, and recurrent postoperative traumatic postsurgical thorac CSF leaks/DT can be limited by performing initially sufficient operative decompressions and/or decompressions/fusions (i.e., utilizing adequate open exposures vs. inadequate minimally invasive (MI) approaches). The incidence of CSF leaks/DT can be further reduced by spine surgeons' utilization of operating microscopes, and their avoiding routine attempts at total synovial cyst excision and/or complete resection of hypertrophied/ossified yellow ligament in the presence of significant dural adhesions. Multiple CSF leak/CT repair techniques included; using interrupted, non-resorbable sutures for direct dural repairs (i.e. 7-0 Gore-Tex sutures where the suture is larger than the needle thus plugging needle holes), and adding where needed muscle patch grafts, microfibrillar collagen, the rotation of Multifidus muscle pedicle flaps, fibrin sealants (FS)/fibrin glues (FG), lumbar drains (LD), and/or lumbo-peritoneal (LP) shunts. Intraoperative, postopertive delayed, and/or recurrent postoperative thorac and/or lumbar traumatic surgical CSF leaks can be reduced by choosing to initially perform the appropriately extensive open operative decompressions and/or decompresssions/fusions. It is critical to use an operating microscope, non-resorbable interrupted sutures, and where necessary, muscle patch grafts, microfibrillar collagen, the rotation of Multifidus Muscle Pedicle Flaps, FS/FG, LD, and/or LP shunts.

An Innovative Therapy by Changing the Gut Microbiome for the Dual Post-Operative Complications of the Recurrent Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the Residual Type II First Branchial Cyst and Facial Nerve Palsy

A very unusual, interesting, and challenging case of a 24-year-old female who was born with three openings in the neck. The patient had chronic abdominal gaseous distention, recurrent abdominal pain, and constipation since early infancy. The patient presented in emergency with acute painful red, hot, and tender swelling in the left upper cervical area. Laboratory studies showed high inflammatory markers and a provisional diagnosis of abscess with a sinus was made. The patient underwent an emergency incision and drainage. Sinus recurred and a sinogram showed it to be a residual cyst in the left submandibular salivary gland. The total cyst excision was attempted with resultant recurrence and grade IV facial nerve palsy. Post-operatively recurrent infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) required several courses of oral and intravenous broad-spectrum antibiotics with several hospital admissions with no resolution in sight. Subsequent ultrasound and magnetic resonance imaging showed a residual infected cyst, cutaneous sinus, and a fistula opening in the left ear canal. A diagnosis of branchial cyst type II of the first brachial cleft remnant with a fistula was established with bilateral branchial fistulas of the second branchial remnants and the associated colorectal hypoganglionosis based on radiological studies. The patient refused any further operative interventions. Therefore, the option of conservative treatment of hypoganglionosis with holobiotics consisting of prebiotics, probiotics and postbiotics, laxatives, dietary changes, lifestyle modifications, and dietary supplements started. All antibiotics were stopped. These therapies resulted in the resolution of residual first branchial remnants and recurrent MRSA infections with the improvement in the facial nerve palsy from grade IV to grade III-IV together with an excellent cosmetic and functional result. The patient is doing well at follow-ups being infection-free for 18 months and repeat contrast-enhanced computed tomogram (CECT) has shown complete resolution of the residual cyst, sinus, and fistula with fibrosis.

Congenital Multilocular Pancreatic Cyst Originating from Head and Body of The Pancreas: A Challenging Diagnosis and Successful Total Cyst Excision

Congenital true pancreatic cysts are seldom findings among other abdominal cysts in children. Diagnosis can be delayed for a few months after birth until the infant presents with an abdominal mass, abdominal distension, or vomiting due to gastric outlet obstruction, total excision of the cyst is the treatment of choice but this is not always feasible. In this article, we report a 3-month -old boy with histologically proven true pancreatic cyst. The cystic mass was located in the right upper quadrant of the abdomen, and total cystectomy was performed without complication.

Endoscopic Assisted Caldwell-Luc Approach for Total Excision of an Extensive Aneurysmal Bony Cyst of the Maxillary Sinus.

Aneurysmal bone cysts (ABCs) are uncommon lesions in head and neck area that could be primary or secondary in origin. The main problem with the traditional curettage and debridement is the high rates of recurrence, and cosmetic disfigurement with the open approach. In this article, we describe the use of a combined endoscopic sinus surgery and endoscopic assisted Caldwell approach to achieve a complete surgical excision of left maxillary sinus ABC extending to the left infratemporal fossa, and to avoid facial disfigurement in a 13-year-old female patient presented to our hospital with diplopia, facial pain, and headache. The patient had uneventful post-operative recovery period with resolution of the presenting symptoms with no complications. Hence, we recommend this combined endoscopic surgical approach in such cases.

Presentation and Management of Choledochal Cysts in Children: The Experience of a Single Institute From a Developing Country

BACKGROUND: Choledochal cysts are rare congenital biliary tract malformations. Presentation is variable based on age at presentation and type of the cyst. Total cyst excision with biliary reconstruction is the treatment of choice.
 AIM OF THE STUDY: to present our experience with the presentation and management of these rare malformations with literature review.
 MATERIALS AND METHODS: A retrospective analysis of a series of seven patients managed during the period from June 2015 to July 2020 in our institution. Recorded clinical data included sex, age at presentation, mode of presentation, diagnostic modality, cyst type and histopathology, preoperative course, operative procedure, and intraoperative and postoperative complications.
 RESULTS: Of the patients enrolled in the study, 5 (71.4%) were female and 2 (28.6%) were male. Age at presentation ranged from 7-36 months. Abdominal pain was the most frequent manifestation and was recorded in 6 (85.7%) patients. The diagnosis was confirmed in all patients with MRCP. Cysts were type I in all (100%) patients. Open total cyst excision with Reux-en-Y hepaticojejunostomy was the standard procedure in all patients. No significant intraoperative vascular or structural injury was recorded. Early postoperative complications were recorded in only 1 (14.3%) patient. All patients achieved good clinical outcome, and none have shown significant findings on long term follow up.
 CONCLUSIONS: Choledochal cysts are rare congenital malformations with variable presentation. Total cyst excision with hepaticojujenostomy is a standard therapeutic option and is associated with an excellent outcome and decreased incidence of long term risks.
 KEYWORDS: Choledochal cyst, Children, Hepaticojujenostomy

Spinal extradural arachnoid cysts: A novel formation mechanism and dural defect location technology

PurposeThe formation mechanism of spinal extradural arachnoid cysts (SEACs) remains unclear. There are several hypotheses for the formation of SEACs, but none of them can fully explain its pathological findings and surgical procedures. In this study, we retrospectively analyzed the cases of SEACs, aiming to clarify the formation mechanism of SEACs. In addition, we summarize a concise method for locating dural defects preoperatively and formulate a putative explanation of this method. MethodsThe clinical data of 14 patients with SEACs underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed. ResultsFourteen patients were identified during the study period. The cysts all spanned the T12/L1 segment, and dural defects were also located at the T12/L1 level (2 cases not recorded) as well as the middle or the upper-middle level of the cysts. Nine cases were treated with total cyst excision, 2 cases were treated with dural defect closure only, and 3 cases were treated with total cyst excision and dural defect closure. Histopathological examination demonstrated that the cyst wall contained both the arachnoid epithelial and compact fibrous connective tissue. The symptoms were relieved in all patients, and no recurrence was observed. ConclusionsAccording to intraoperative and pathological findings, the dural outer layer cyst (DOLC) is a more reasonable hypothesis about SEACs formation. When CT myelography or cinematic MRI cannot determine the location of the dural defect preoperatively, it can be located according to the middle level of the SEACs with high accuracy.

Genetic and Idiopathic chronic pancreatitis display distinct clinical features at diagnosis.

A 4-year-old female was referred to our institution with acute pancreatitis due to a choledochal cyst. A protein plug was found to be deeply impacted in the main pancreatic duct. She underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincteroplasty and extraction of the protein plug with a basket extractor. After the ERCP procedure, the patient successfully underwent total choledochal cyst excision with Roux-en-Y hepaticojejunostomy. In cases in which a huge protein plug is located deep in the pancreatic duct, therapeutic ERCP is useful as preoperative management for choledochal cyst excision with hepaticojejunostomy.

Total robotic choledochal cyst excision with Roux-en-Y hepaticojejunostomy in adults

Choledochal cyst (CDC) excision with bilio-enteric anastomosis has been reported by a laparoscopic approach. With the advent of robotic surgery, it is likely to simplify the performance of such complex procedures. Herein, we present our technique of total robotic CDC excision with intra-corporeal Roux-en-Y hepaticojejunostomy (RYHJ). The patient was placed in a reverse Trendelenburg position. The robotic ports were placed in a "C"-shaped manner, with the camera port placed ~2 cm below the umbilicus. A 12-mm assistant port was placed in between the camera and the left-sided robotic port. Robotic dissection and excision of extrahepatic part CDC were performed, and subsequently, intra-corporeal robotic RYHJ with jejunojejunostomy was completed. Intra-operatively, indocyanine green dye was used to delineate the biliary anatomy and to check the anastomotic integrity. All three patients were female with a median age of 21 (18-34) years. Two patients had type IVa, and one had a mixed variant of type I(C) with type VI. The median operative time was 420 min, whereas docking and console time was 22 (20-25) min and 400 (360-450) min, respectively. The median blood loss and length of hospital stay were 50 (50-100) ml and 6 (5-6) days, respectively. One patient has mild acute pancreatitis in the post-operative period, which was managed conservatively. Robotic CDC excision and reconstruction seem to be a safe, feasible, and effective surgical option that provides the benefits of minimal access surgery but also greatly aids in complex dissection and reconstruction.

A Retroperitoneal Peritoneal Cyst, a Rare Cystic Lesion, Case Report

Background: Retroperitoneal cystic masses are benign fluid filled lesions arising within the retroperitoneal space surrounding the organs of the compartment. Peritoneal cysts are defined as tumors of the abdomen and pelvic peritoneum. Both are rare conditions that commonly assume an asymptomatic presentation, posing a challenge in diagnosis. Case presentation: A 42-year-old male was admitted to the surgical ward for right lower abdominal pain which had been present for one year. Ultrasound revealed that the mass was cystic in consistency and localized to the right side of the urinary bladder having debris and multiple calcifications. Intraoperatively, a retroperitoneal mass (cyst) about (9×9cm) in size was found adherent to the surrounding tissue, and when opened, fluid and mucus gelatinous material with debris and two staghorn stones (3×3cm) were found inside it. The mass extended downward through the right femoral canal to the thigh. An incision below the right inguinal ligament was done, and another stag horn of (3×3cm) size was found inside it. Total excision of the whole cyst was performed. Fluid was sent for cytopathology for microscopic examination, and the result was negative for malignancy. Conclusion: A rare incidence of retroperitoneal peritoneal cyst grows to massive measures and thus leads to nonspecific abdominal symptoms. Total excision is the treatment of choice for this case.

Alveolar echinococcosis located in the liver: Report of a case

Echinococcosis is a parasitic infection caused by larval and cyst stages of Echinococcus granulosus living in dogs in humans. The definitive host of the parasite is dog, intermediate hosts are sheep, cattle and humans. The causative pathogen is mostly Echinococcus granulosus. Echinococcus multilocularis (alveolaris) and other agents are less common. Only 3% of hepatic hydatid cysts are alveolar hydatid cysts. In this study, we aimed to present a case of Alveolar echinococcosis located in the right lobe of the liver due to Ecinococcus alveolaris, together with the operation images. We evaluated the preoperative, peroperative and postoperative course of a patient who was examined with abdominal pain in our clinic and in radiological and serological examinations, we found an alveolar hydatid cyst located in the liver and underwent surgery. Our patient was a 31-year-old female. She applied for abdominal pain. Ultrasonography revealed a cystic mass of approximately 17 cm in diameter in the right lobe of the liver. In laboratory examinations, the hydatid hemagglutination test was positive at a titer of 1/2560. Hematological and biochemical parameters were normal. MRI showed a 171*125 mm sized, lobulated, locally calcified cystic mass in the right lobe of the liver. After evaluating the relationship of the lesion defined in CT angiography imaging with vascular structures, the decision to operate was made with the diagnosis of Alveolar echinococcosis.. Nonanatomical segmental right hepatectomy and total cyst excision operation was performed in our patient who was thought to have Alveolar echinococcosis based on clinical, serological and radiological findings. The patient, who had an uneventful postoperative period, was discharged on the 7th postoperative day with full recovery. In cases of echinococcosis, the treatment is determined according to the type of the agent, the stage and localization of the lesion. Medical treatment, PAIR and surgery are the treatment options that can be applied. Total excision of the mass is recommended in cases of Alveolar echinococcosis.

Giant, primary, hydatid cyst of the gluteal region

Background: Primary hydatid disease in the muscle is extremely rare, resulting in either the spread of cysts spontaneously or after operations for hydatidosis in distant regions.
 Methods: Report of an unusual case of primary hydatid cyst in the gluteus muscle, behaving as enlarging soft-tissue tumour, with a review of the literature.
 Results: Magnetic resonance imaging revealed an intramuscular cyst in the gluteus muscle; and no cyst existed in any other location. The cyst was excised totally, and the diagnosis of muscular cystic hydatidosis was confirmed by histopathologic examination. In follow-up of two years after the operation, there has been no recurrence in either patient.
 Conclusion: The involvement of the gluteus maximus muscle without the evidence of hepatic or pulmonary disease is rare, characterized by slow development, but a major local extension must be considered in the differential diagnosis of a cystic mass with well-defined margins in the extremities of individuals from endemic regions. Physical examination, serology results and radiological findings should be interpreted with care, especially in hydatid cyst endemic countries. Surgery is still the treatment of choice, with total cyst excision.

Laparoscopic hepaticoduodenostomy for choledochal cysts in children

Context:Choledochal cyst (CHC) is one of the most common causes of surgical jaundice in infants. In 1955, Farello et al. were the first to introduce the laparoscopic approach for treatment of CHC.Aim of the Study:Minimally invasive approaches to the management of CHC excision have been done in pre-schoolers and above but have not yet been described in toddlers, let alone infants. Herein, we review the results of 10 consecutive children <1 year managed with laparoscopic CHC excision and hepaticoduodenostomy.Methods:This retrospective study investigated 10 infants who underwent laparoscopic resection of a CHC with creation of a hepaticoduodenostomy.Results:This study was performed on 10 consecutive patients <1 year. Liver fibrosis was found in 4 patients. We had 7 cases with Type 1 CHCs and 3 cases with Type IV A cysts. Total cyst excision was done in all patients, no cases needed blood transfusion and the mean operative time was 200 min. The mean hospital stay was 6 days. Overall, morbidity occurred in 20% of the cases presenting with bouts of cholangitis that resolved without any intervention, once at 6 months, the other at 1-year post-operative. There were neither anastomotic strictures nor biliary fistula formation; magnetic resonance cholangiopancreatography was done to these two cases revealed no stricture and mortality at 30 and 90 days was nil.Conclusion:Laparoscopic hepaticoduodenostomy in CHC in children <1 year is safe, with satisfactory short-term results.

Management of a Giant Hepatic Cyst by Total Cyst Enucleation in Uganda. A Case Report and Review of Literature

Introduction: Giant hepatic cysts are uncommon and cause symptoms due to compression effects. Symptoms include early satiety, abdominal discomfort, abdominal mass and rarely pain in case of haemorrhage, rupture or cyst infection. Aetiology is unknown but liver cysts are thought to be congenital. Management if liver cysts is debatable but options include sclerotherapy, fenestration or deroofing, open or laparoscopic partial or total cyst excision, cyst enucleation and rarely liver resection. There is paucity of data on management of Giant liver cysts in Uganda and the East African region and to the best of our knowledge, this is the first reported case in our country and region. Method: We present a sixty one year old female Ugandan who was admitted due to an increasing abdominal mass with associated discomfort and early satiety. Contrasted abdominal computed tomography (CT) scan revealed a 28 x 26 cm simple liver cyst. Results: She underwent open total cyst enucleation after initial cyst decompresion. Postoperative recovery was uneventful and she was discharged on the 8th postoperative day. Conclusion: It is easier to perform a total cyst excision or enucleation for Giant liver cyst with a thick wall or cyst capsule. Figure 1: Abdominal CT scan of the giant liver cyst (top left), intraoperative intact cyst (top middle), cyst dissection (top right), detaching cyst from inferior vena cava (bottom left), atrophied right lobe and hypertrophied left lobe (bottom middle), after total cyst excision/enucleation (bottom right)

Choledochal cyst with aberrant right posterior duct

Choledochal malformation, previously known as “choledochal cyst” is the congenital dilatation of any portion of the biliary tree. Its incidence varies from 1 in 48,000 in UK to 1 in 1000 in Japan. Type 1 is the most common one. Surgical options include total cyst excision with roux en Y hepaticojejunostomy or hepaticoduodenostomy for type 1. Detailed knowledge about normal extrahepatic biliary tract and its variations is needed to prevent complications. These aberrations of the anatomical structures of vascular and ductal structures make any hepatobiliary surgery challenging to surgeons. The normal configuration is present in around 60% of the population. We report a rare case of choledochal cyst patient in which there was a right posterior duct aberration with double cystic ducts and one of the cystic ducts opened into the distal portion of aberrant duct. There was a need for double anastomosis of hepaticojejunostomy rather than one, as ligating the aberrant duct would have caused segmental cirrhosis and later atrophy. Failure to identify the aberrant vessel would have caused prolonged bile leakage in the postoperative period. Therefore, assessment of the biliary anatomy and identification of normal variants are challenging points in the surgical planning. • Choledochal malformation, previously known as “choledochal cyst” is a rare disease. • The aberrations of the anatomical structures of vascular and ductal structures make any hepatobiliary surgery challenging to surgeons. • We report a rare case of choledochal cyst patient in which there was a right posterior duct aberration with double cystic ducts and one of the cystic ducts opened into the distal portion of aberrant duct. • There was a need for double anastomosis of Roux en Y hepaticojejunostomy rather than one.

Total versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in children with choledochal cysts: a case\u2013control study

BackgroundTo compare the efficacy of total and conventional laparoscopic hepaticojejunostomy (TLH and CLH) in children with choledochal cysts (CDCs).MethodsData from patients undergoing TLH and CLH between August 2017 and December 2018 were retrospectively analyzed. Intraoperative blood loss, time for jejunum-cojejunum anastomosis, time to oral intake, postoperative hospital stay, hospitalization expenses, and postoperative complications were compared.ResultsAll 55 patients (TLH = 30, CLH = 25) were successfully treated without conversion to open surgery. In the TLH and CLH groups, the time to oral intake was 3.57 ± 0.19 d and 4.56 ± 0.27 d, respectively (t = 3.07, P < 0.01), the postoperative hospital stay was 5.50 ± 0.28 d and 7.00 ± 0.74 d (t = 2.03, P < 0.05), and the hospitalization expenses were CNY 40,085 ± 2447 and CNY 26,084 ± 2776 (t = 3.79, P < 0.001). There were no significant differences in intraoperative blood loss (9.57 ± 3.28 ml vs 8.2 ± 1.13 ml, t = 0.37, P = 0.72) or time for jejunum-cojejunum anastomosis (80.5 ± 2.46 min vs 75.00 ± 2.04 min, t = 1.68, P = 0.10). The median follow-up periods of the TLH and CLH groups were 17 and 16 months, respectively. Overall complication rates were comparable between the two groups (10% vs 8%, χ2 = 0.07, P = 0.79).ConclusionsTLH in children with CDCs has the advantages of rapid gastrointestinal functional recovery and a short hospitalization. However, hospitalization is relatively expensive.

Submandibular dermoid cyst resembling a plunging ranula

Abstract A case of a submandibular dermoid cyst misdiagnosed ranula will be discussed. Sclerotherapy and sublingual gland excision were performed, but, the cyst persisted. A biopsy of the internal surface epithelium was needed for definitive diagnosis, and total cyst and duct excision was performed as the appropriate treatment.

A 16-year old man with an intradural extramedullary arachnoid cyst in the spine: a rare case

Intradural extramedullary arachnoid cyst in the spine is an extremely uncommon cyst, only 5% occurs in the spine. This cyst rarely causes compression to the spinal cord. The etiology of this cyst is not known for certain, but the majority of which is congenital with other possible causes such as trauma, infection, inflammation, postoperative complication, and lumbar puncture. Arachnoid cyst is categorized into three types according to Nabor et al, which is type I (IA and IB), type II, and Type III. Diagnosis establishment was carried out through imaging modality of MRI with contrast. If the case is asymptomatic, observation as a conservative therapy is advised. Total cyst excision is recommended for patients with clinical symptoms and severe neurological damage. In this article, we report a case of a 16-year-old male patient who came with the main complaint of neck pain that radiated to the upper back, down to his arms and both of his hands for the past 4 months before hospital administration. This was followed by weaknesses in all of his extremities and difficulties when urinating and defecating. Based on MRI, C3-C5 intradural extramedullary arachnoid cyst was detected and the patient had undergone total cyst excision surgery with a promising result that shows the increased value for the four limbs and decreased pain. An intradural extramedullary arachnoid cyst is an extremely rare cyst. This case utilized MRI with contrast as the imaging modality, proving to be very helpful in establishing diagnosis.

A Rare Case of Mucinous Cystadenoma Presenting as Unilateral Proptosis at Birth

Mucinous cystadenoma is a rare cause of unilateral proptosis at birth. A two day old female baby presented with non-pulsatile, transiliuminantaxial proptosis right eye. On CT scan cystic lesion was seen behind the globe in retrobulbar space. Gross total excision of cyst was done through trans-frontal craniotomy approach. Histopathological examination revealed mucinous cystadenoma. This case has been reported because of rarity of this condition.

Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics: Report of 10 cases

BackgroundThe robotic surgery has been proposed as another adjunct for pediatric minimal surgery for choledochal cyst. However, the Roux-en-Y jejunal limb in most reports on robot-assist choledochal cyst resection is usually created extracorporeally in children. The pediatric surgery team of West China Hospital of Sichuan University had completed 10 cases of total robot-assisted choledochal cyst resection. The aim of this current study was to present our initial experience in total robot-assisted surgery and discuss the technical points. MethodsBetween January 2015 and February 2020, patients with choledochal cysts treated with total robot-assisted procedures were retrospectively analyzed. The data collected included demographic information of all patients, type and size of cyst, operative details and postoperative outcomes. ResultsA total of 10 episodes of patients were enrolled in the study. The median age of the patient was 69.50 months with a mean weight of 20.50 kg. The most common symptoms were abdominal pain, vomiting, and jaundice (60%, 30%, and 30%, respectively). The types of cyst included 2 Ia, 7 Ic and 1 IV. The mean operation time was 218.70 min and there were no red blood cell transfusion and conversion in the 10 patients. The mean time to taking water was 3.37 days and mean time to starting liquid diet was 3.77 days. And the average length of postoperative hospital stay was 7.92 days. All 10 patients were eventually discharged and made uneventful recoveries after the operation. ConclusionsTotal robot-assisted choledochal cyst excision comprising Roux-en-Y limb formation, excision of the cyst and hepaticojejunostomy appears to be safe and feasible in pediatrics. Our initial experience shows that it is recommended to perform total robot-assisted choledochal cyst excision for patients over 4 years while a Roux-en-Y jejunojejunal anastomosis is recommended to be performed extracorporeally by prolapsing the jejunum out of abdominal cavity for patients under 4 years old. Level of evidenceTreatment Study. Type of studyRetrospective Study.