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Robotic-assisted choledochal cyst excision with Roux-en-Y hepaticojejunostomy in children: does age matter?
Liying Rong1, Yibo Li1, Jingfeng Tang2
1Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Robotic-assisted surgery (RAS) is safe and effective for infants under one year old with choledochal cysts (CCs). Outcomes in this young group are comparable to older children, making age not a contraindication for RAS.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Robotic-assisted surgery (RAS) is increasingly adopted for pediatric choledochal cysts (CCs).
- Outcomes of RAS in infants under one year old remain under-explored.
- This study compares RAS outcomes in infants versus older children with CCs.
Purpose of the Study:
- To evaluate the feasibility and safety of RAS in infants (≤1 year) with CCs.
- To compare surgical outcomes between infants and older children undergoing RAS for CCs.
- To determine if age is a contraindication for RAS in pediatric CCs.
Main Methods:
- Retrospective study of 79 patients with CCs from July 2015 to January 2020.
- Patients divided into two groups: Group A (infants ≤1 year) and Group B (>1 year).
- Analysis of demographics, intraoperative details, complications, and outcomes.
Main Results:
- No significant differences in demographics or cyst characteristics between groups.
- Infants had smaller common hepatic ducts but longer hepaticojejunostomy times.
- Total operative time, console time, hospital stay, and complication rates were similar between groups. No conversions to open surgery were needed.
Conclusions:
- Robot-assisted cyst resection and hepaticojejunostomy are feasible and safe in infants ≤1 year old.
- RAS offers comparable outcomes to older children for choledochal cysts.
- Age should not be considered an absolute contraindication for robotic surgery in pediatric CCs.
Background:
Robotic-assisted surgery (RAS) is being increasingly used in pediatric choledochal cysts (CCs), but is most commonly performed in older children and adolescents. The outcomes in young infants remain to be explored. The purpose of this study is to compare outcomes in infants aged ≤ 1 year with an older cohort.
Methods:
From July 2015 to January 2020, a retrospective study was conducted to evaluate the RAS in patients with CCs at our institution. Patients were divided into two groups (group A ≤ 1 year old and group B > 1 year old). Demographics, intraoperative details, complications, and outcomes were analyzed.
Results:
A total of 79 patients were included in the study (28 patients in group A and 51patients in group B). The median age of patients at the surgery in group A was 4.9 months (IQR: 3.1-9.1), compared with 46.8 months (IQR: 28.5-86.5) in group B. Three patients in group A were neonates. No conversion to open surgery was required. No significant differences were found between the two groups including sex, Todani type, or diameter of the cysts. The diameter of the common hepatic duct was smaller in group A (6.0 ± 1.7 vs. 9.0 ± 3.0 mm; p < 0.001). Group A had the longer hepaticojejunostomy time [51(44-58) vs. 42(38-53) min; p = 0.013], while Group B had the longer cyst excision time [43(41-59) vs. 50(43-60) min; p = 0.005]. However, their total operative time and console time were similar. There were no statistical differences in length of hospital stay and complications between the two groups.
Conclusions:
Robot-assisted cyst resection and hepaticojejunostomy are feasible and safe in infants ≤ 1 year old. Age cannot be considered an absolute contraindication for robotic surgery in patients with CCs.
