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Updated: Oct 14, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Changes in outcomes and operative trends with pediatric robot-assisted resection of choledochal cyst
Kyong Ihn1, In Geol Ho1, Young Ju Hong2
1Department of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Insights
Robot-assisted resection of choledochal cysts (CCs) in pediatric patients is safe and feasible. This technique shows improved operative times and reduced emergency visits with increased surgeon experience.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Choledochal cysts (CCs) are congenital biliary tract abnormalities requiring surgical intervention.
- Robot-assisted surgery offers potential advantages in complex pediatric procedures.
- This study evaluates the learning curve and outcomes of robot-assisted CC resection in children.
Purpose of the Study:
- To report the experience and outcomes of robot-assisted resection of choledochal cysts in pediatric patients.
- To analyze changes in operative trends and clinical outcomes over time.
- To assess the safety and feasibility of this approach in a high-volume pediatric center.
Main Methods:
- Retrospective review of 158 pediatric patients (<18 years) undergoing robot-assisted CC resection.
- Patients divided into two periods: P1 (July 2008-March 2016) and P2 (April 2016-January 2021).
- Comparison of operative characteristics and postoperative prognosis between P1 and P2 groups.
Main Results:
- Mean operative time decreased significantly from 462.6 min (P1) to 383.6 min (P2) (p<0.001).
- Estimated blood loss was lower in P2 (28 mL) compared to P1 (63 mL) (p=0.025).
- Postoperative emergency department visits were reduced in P2 (3.8%) versus P1 (13.9%) (p=0.047).
Conclusions:
- Robot-assisted resection of choledochal cysts is a safe and feasible option for pediatric patients.
- Increasing institutional experience with robotic surgery improves operative efficiency and patient outcomes.
- This approach demonstrates a favorable learning curve and clinical benefits in pediatric CC management.
Background:
This study aimed to report our experience with a robot-assisted resection of choledochal cysts (CCs) in pediatric patients, especially focusing on changes in outcomes and operative trends.
Methods:
We retrospectively reviewed medical records of all 158 patients under 18 years of age who underwent robot-assisted resection of CC in a single tertiary center between July 2008 and January 2021. Patients were divided into the first period (P1, July 2008-March 2016; N = 79) and second period (P2, April 2016-January 2021; N = 79) with equal number of participants. The patients of P2 were compared with those of P1 to assess clinical outcomes with operative details. Operative characteristics and postoperative prognosis were compared for each group.
Results:
The mean operative time was 383.6 min for the P2 group and 462.6 min for the P1 group (p < 0.001). The mean estimated blood loss was 28 mL in the P2 group and 63 mL in the P1 group (p = 0.025). The rate of emergency department visit after the operation was lower in the P2 group (3.8% vs. 13.9%, respectively, p = 0.047). The two groups showed no significant differences in the rate of late postoperative complications and reoperations.
Conclusion:
With the increase in the center's experience, robot-assisted resection of CC can be safely adopted and feasible, especially for pediatric patients.
Levels Of Evidence:
Treatment Study, Level III.
