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A trans-umbilical single-site plus one robotic-assisted surgery for choledochal cyst resection in children
Yucan Lin1, Shan Chen2, Yang Lin1
1Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Insights
Trans-umbilical single-site robot-assisted surgery for choledochal cysts offers faster recovery and less bleeding than laparoscopy. However, it involves longer operative times and higher costs, though it shows potential to replace laparoscopy in the future.
Area of Science:
- Minimally Invasive Surgery
- Pediatric Surgery
- Surgical Robotics
Background:
- Choledochal cysts are congenital bile duct dilatations requiring surgical intervention.
- Trans-umbilical single-site surgery aims to minimize scarring and improve cosmetic outcomes.
- Robot-assisted surgery offers enhanced dexterity and visualization in minimally invasive procedures.
Purpose of the Study:
- To compare intraoperative and postoperative outcomes of trans-umbilical single-site robot-assisted surgery versus trans-umbilical single-site laparoscopic surgery for choledochal cysts.
Main Methods:
- Retrospective analysis of clinical data from 49 pediatric patients with choledochal cysts.
- Patients were divided into two groups: trans-umbilical single-site robot-assisted surgery (n=24) and trans-umbilical single-site laparoscopic surgery (n=25).
- Comparison of intraoperative parameters (e.g., bleeding, operative time) and postoperative outcomes (e.g., complications, recovery time, hospitalization).
Main Results:
- Robot-assisted surgery group showed significantly less intraoperative bleeding (p<0.001).
- Postoperative outcomes favored the robot group with shorter drainage tube indwelling time (p<0.001), fasting time (p<0.001), and hospitalization time (p<0.001).
- The robot group experienced longer operative times (p=0.050) and higher hospitalization expenses (p<0.001).
Conclusions:
- Trans-umbilical single-site robot-assisted surgery leads to quicker recovery and less tissue damage but incurs higher costs and longer operative duration compared to laparoscopy.
- Robot-assisted surgery demonstrates potential to surpass laparoscopy due to its advantages, especially with increasing system availability and surgeon experience.
Objective:
The purpose of this study is to compare the intraoperative and postoperative outcomes of a trans-umbilical single-site plus one robot-assisted surgery and a trans-umbilical single-site laparoscopic surgery in the treatment of choledochal cysts.
Methods:
We retrospectively analyzed clinical data from 49 children diagnosed with choledochal cysts who were admitted to our hospital between June 2020 and December 2023. Among these patients, 24 underwent a trans-umbilical single-site plus one Da Vinci robot-assisted surgery (the robot group) and 25 underwent a trans-umbilical single-site laparoscopic-assisted surgery (the laparoscopic group). We compared differences in intraoperative and postoperative outcomes between the two groups.
Results:
There was no significant difference between the two groups of patients in terms of gender, age, weight, clinical symptoms, maximum cyst diameter, type, postoperative complications, and facial expression, leg movement, activity, crying, and comfortability (FLACC) scoring (p > 0.05). Compared with the patients in the laparoscopic group, those in the robot group had less intraoperative bleeding [10 (8-12) vs. 15 (11.5-18) ml, p < 0.001] and required less postoperative drainage tube indwelling time [5 (4-6) vs. 7 (5.5-8) day, p < 0.001], less postoperative fasting time [4 (3-4) vs. 6 (5-7) days, p < 0.001], and less postoperative hospitalization time [6 (6-7) vs. 8 (6-10) days, p < 0.001], but they required more operative time [385.5 (317.0-413.3) vs. 346.0 (287.0-376.5) min, p = 0.050] and consumed more hospitalization expenses (79,323 ± 3,124 vs. 31,121 ± 2,918 yuan, p < 0.001).
Conclusion:
The results of this study showed a shorter hospitalization time, quicker postoperative recovery, and less tissue damage but a higher cost and a longer operation time in patients who chose robotic surgery rather than laparoscopic surgery. With the continuous expansion of the scale of installed robot-assisted surgical systems and the gradual accumulation of the technical experience of surgeons, robot-assisted surgery may slowly surpass, and shows a trend to replace, laparoscopy because of its advantages.
