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Updated: May 15, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Robot-assisted vs. laparoscopic-assisted surgery for choledochal cyst in children: a systematic review and
1Department of General Surgery, The Second People's Hospital, Yibin, Sichuan, China.
Insights
Robot-assisted surgery (RS) shows promise in treating pediatric choledochal cysts (CC), reducing complications and hospital stays compared to laparoscopic surgery (LS). While operative time is longer, RS offers significant benefits for patient recovery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Comprehensive comparative analyses of robot-assisted surgery (RS) versus laparoscopic surgery (LS) for pediatric choledochal cysts (CC) are limited.
- Evaluating the safety and efficacy of these surgical approaches is crucial for optimizing pediatric CC treatment.
Purpose of the Study:
- To systematically compare the safety and efficacy of robot-assisted surgery (RS) against laparoscopic surgery (LS) in the treatment of choledochal cysts (CC) in children.
- To identify potential advantages and disadvantages of each surgical modality based on current evidence.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) for studies comparing RS and LS in pediatric CC patients.
- Meta-analysis of data from 19 retrospective studies was performed using Stata 18 to evaluate various surgical outcomes.
- Outcomes assessed included complication rates, operative time, blood loss, and postoperative recovery metrics.
Main Results:
- Robot-assisted surgery (RS) demonstrated significantly lower incidences of postoperative biliary stones, bile leakage, anastomotic stricture, and overall complications compared to laparoscopic surgery (LS).
- RS was associated with longer total operative time but significantly lower intraoperative blood loss.
- Patients undergoing RS experienced shorter hepaticojejunostomy time, drainage tube indwelling time, postoperative fasting duration, and hospital stay.
Conclusions:
- Robot-assisted surgery (RS) offers potential advantages in treating pediatric choledochal cysts (CC), including reduced postoperative complications, decreased blood loss, and accelerated recovery.
- While operative time is longer with RS, this may be offset by experience and technological advancements.
- Further high-level evidence from multicenter prospective studies or randomized controlled trials is needed to validate these findings.
Objective:
Comprehensive analyses specifically comparing robot-assisted surgery(RS) and laparoscopic surgery(LS) for choledochal cyst(CC) in children remained scarce. This study aimed to evaluate the safety and efficacy of RS vs. LS for pediatric CC.
Methods:
A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted to identify studies published up to December 31, 2025, that compared laparoscopic and robot-assisted surgery for CC in children. Meta-analysis was performed using Stata 18.
Results:
A total of 19 retrospective studies were included. Meta-analysis results demonstrated that the RS group had significantly lower incidences of postoperative biliary stones (OR = 0.10, 95% CI: 0.01-0.89), bile leakage (OR = 0.28, 95% CI: 0.11-0.70), anastomotic stricture (OR = 0.27, 95% CI: 0.12-0.65), and overall complications (OR = 0.26, 95% CI: 0.13-0.51) compared to the LS group. Total operative time was longer in the RS group (SMD = 1.02; 95% CI: 0.30-1.74), whereas intraoperative blood loss was significantly lower (SMD = -1.22; 95% CI: -2.19 to -0.24). Additionally, the RS group exhibited shorter hepaticojejunostomy time (SMD = -1.43; 95% CI: -2.30 to -0.56), drainage tube indwelling time (SMD = -0.74; 95% CI: -1.01 to -0.47), postoperative fasting time (SMD = -0.80; 95% CI: -1.11 to -0.50), and hospital stay (SMD = -1.16; 95% CI: -2.08 to -0.23). No significant differences were observed in other outcomes, including postoperative cholangitis (OR = 0.59, 95% CI: 0.22-1.57), residual cyst (OR = 0.22, 95% CI: 0.02-1.94), incision infection (OR = 0.17, 95% CI: 0.02-1.41), intestinal obstruction (OR = 0.97, 95% CI: 0.40-2.33), pancreatitis (OR = 0.74, 95% CI: 0.08-6.47), pancreatic leakage (OR = 0.43, 95% CI: 0.10-1.92), and conversion to open surgery (OR = 0.79, 95% CI: 0.36-1.75). Furthermore, no statistically significant difference was found in cyst excision time between the two groups (SMD = -1.77; 95% CI: -3.91 to -0.77).
Conclusion:
In the treatment of pediatric CC, RS offered potential advantages over LS in terms of reducing postoperative biliary-related complications, decreasing intraoperative blood loss, accelerating postoperative gastrointestinal function recovery, and shortening hospital stay. Although RS required longer operative time, this limitation might be mitigated with accumulated surgical experience and technological advancements. However, current evidence is primarily derived from retrospective studies conducted in Asian countries and lacked long-term follow-up data. Well-designed multicenter prospective studies or randomized controlled trials were urgently needed to provide higher-level evidence and further validate our findings.