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Published on: December 20, 2024
[Robot-assisted choledochal cyst resection in a child]
Yu Yu Sokolov1,2, A M Efremenkov1,2, A P Zykin1,2
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
Insights
Robot-assisted surgery offers a safe and effective alternative for treating choledochal cysts in children. This minimally invasive approach overcomes laparoscopic limitations, enabling successful resection and reconstruction.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Minimally Invasive Surgery
Background:
- Choledochal cysts require surgical intervention, typically involving bile duct resection and reconstruction.
- Minimally invasive techniques are preferred in pediatric surgery but face challenges in narrow surgical fields.
- Robotic surgery presents a potential solution to overcome laparoscopic limitations in complex pediatric hepatobiliary procedures.
Observation:
- A 13-year-old female patient underwent robot-assisted resection of a hepaticocholedochal cyst and cholecystectomy.
- The procedure included a Roux-en-Y hepaticojejunostomy, with a total anesthesia time of 6 hours.
- The robotic stage facilitated precise dissection and reconstruction in the confined surgical area.
Findings:
- The robot-assisted surgery was successfully completed with no intraoperative complications.
- The patient experienced an uneventful postoperative recovery, with early initiation of enteral nutrition and timely drainage removal.
- Discharge occurred on postoperative day 10, with a favorable 6-month follow-up.
Implications:
- Robot-assisted resection is a feasible and safe option for treating choledochal cysts in pediatric patients.
- This technology can enhance the capabilities of minimally invasive surgery in complex pediatric hepatobiliary cases.
- Further adoption of robotic platforms may expand treatment options and improve outcomes for children with congenital bile duct anomalies.
Abstract:
The generally accepted method for choledochal cysts is total resection of cystic extrahepatic bile ducts and gallbladder followed by biliodigestive anastomosis. Minimally invasive interventions have recently become the «gold» standard in pediatric hepatobiliary surgery. However, laparoscopic resection of choledochal cysts has certain disadvantages related to difficult positioning of instruments in narrow surgical field. The disadvantages of laparoscopy can be compensated by surgical robots. A 13-year-old girl underwent robot-assisted resection of hepaticocholedochal cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. Total anesthesia time was 6 hours. Laparoscopic stage took 55 min, docking of robotic complex - 35 min. Robotic stage of surgery required 230 min, removal of cyst and suturing the wounds - 35 min. Postoperative period was uneventful. Enteral nutrition was started after 3 days, and drainage tube was removed after 5 day. The patient was discharged after 10 postoperative days. The follow-up period was 6 months. Thus, robot-assisted resection of choledochal cysts in children is possible and safe.
