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Whole-Course Intraperitoneal Robot-Assisted Choledochal Cyst Excision with a Hidden Incision in Children Under 1 Year
Yingquan Zhuo1,2, Xianwu Yang1,2, Jun Du1
1Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Insights
Robot-assisted choledochal cyst resection using a Pfannenstiel incision is feasible and safe in infants. This approach offers cosmetic benefits and is suitable for children under one year old.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Choledochal cyst resection in infants presents technical challenges.
- The Pfannenstiel incision, common in adults for cosmetic reasons, is rarely used in pediatric surgery.
- Intraperitoneal robot-assisted surgery offers potential benefits for complex pediatric procedures.
Purpose of the Study:
- To assess the feasibility, safety, and cosmetic outcomes of whole-course intraperitoneal robot-assisted choledochal cyst resection with a Pfannenstiel incision in children under one year of age.
- To evaluate the surgical technique's applicability and patient recovery in this specific pediatric population.
Main Methods:
- Prospective, single-center study involving ten infants under one year old.
- All patients underwent whole-course intraperitoneal robot-assisted choledochal cyst resection using a Pfannenstiel incision.
- Data collected included operative time, anesthesia duration, docking time, blood loss, postoperative recovery, and scar assessment.
Main Results:
- The procedure was successfully completed in all ten patients without conversion to laparotomy.
- Average operative time was 223 minutes, with an average blood loss of 16 mL.
- No postoperative complications were observed; patients had a mean recovery time of 2.4 days for oral intake and 2.6 days for drain removal, with an average hospital stay of 8.5 days.
- Cosmetic scar assessment indicated a high degree of concealment, with 75% of scars hidden by undergarments.
Conclusions:
- Whole-course intraperitoneal robot-assisted choledochal cyst resection with a Pfannenstiel incision is a feasible and safe option for infants under one year old.
- The technique provides favorable cosmetic results due to the hidden nature of the incision.
- This approach is recommended for wider adoption in pediatric surgical practice.
Abstract:
Whole-course intraperitoneal robot-assisted choledochal cyst resection in children under 1 year of age is controversial due to its technical challenges. Current Pfannenstiel incision is widely used in adults for its cosmetic effects but is rarely used in children. We conducted a prospective, single-center study to assess the feasibility, safety, and cosmesis of whole-course intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year of age. Ten patients were treated with our surgical protocol, and there was no conversion to laparotomy. The average total operation time was 223 minutes. The average duration of anesthesia was 260.2 minutes. The average docking time between the robot arm and Trocar was 17.5 minutes. The average intraoperative blood loss was 16 mL. No postoperative complications occurred in the 10 patients. The mean time to start drinking water after surgery was 2.4 days. The mean postoperative drainage tube removal time was 2.6 days. The average length of stay was 8.5 days. The scar assessment scale total scores of the 2 observers were (6.8 ± 1.23) and (7.4 ± 1.84), respectively. For every patient, there are only four abdominal surgery scars of which 75% of scars were hidden by underpants and 25% of scars were not covered. It is feasible and safe to perform whole-courses intraperitoneal robot-assisted choledochal cyst resection with Pfannenstiel incision in children under 1 year old. It also has a hidden incision effect and is worthy of promotion.
