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Comparison of Robot-Versus Laparoscopy-Assisted Resection of Choledochal Cysts in Infants Aged Less than 3 Months
Ken Chen1, Shuhao Zhang1, Yuebin Zhang1
1Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescent's Health and Diseases, Hangzhou 310052, China.
Insights
Robot-assisted surgery for infant choledochal cysts is safe and effective, showing shorter recovery times than laparoscopic surgery. While costs are higher, robotic procedures offer significant benefits for young patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Robotics
Background:
- Robot-assisted surgery (RAS) is increasingly used in pediatric procedures, especially for complex reconstructions.
- Choledochal cysts are congenital bile duct anomalies requiring surgical intervention.
- Evaluating RAS safety and efficacy in very young infants (<3 months) is crucial.
Purpose of the Study:
- To assess the safety and effectiveness of robotic-assisted resection of choledochal cysts in infants under 3 months old.
- To compare outcomes between robotic-assisted surgery (RAS) and laparoscopic-assisted surgery (LAS) in this patient cohort.
Main Methods:
- Retrospective review of 73 infants with choledochal cysts (April 2019 - December 2025).
- Patients divided into RAS (n=39) and LAS (n=34) groups.
- Statistical analysis using Mann-Whitney U, independent-samples t-test, and Fisher's exact test.
Main Results:
- RAS group showed significantly shorter postoperative hospital stay (p=0.004) and drainage tube duration (p=0.002).
- Hepaticojejunostomy time was significantly reduced in the RAS group (p<0.0001).
- LAS group had lower hospitalization costs (p<0.0001), but RAS had fewer major complications like anastomotic fistulas.
Conclusions:
- Robotic-assisted resection of choledochal cysts is safe and effective in infants under 3 months in experienced centers.
- RAS offers advantages in recovery time, though hospitalization costs are higher.
- Further research into RAS for pediatric choledochal cyst resection is warranted.
Abstract:
Background: The utilization of robot-assisted surgery in pediatric patients is increasing, with particularly notable advantages in complex reconstructive procedures. This study aims to evaluate the safety and efficacy of robotic-assisted resection of choledochal cysts in infants aged less than 3 months. Methods: A total of 73 infants with choledochal cysts who were admitted to the Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, between April 2019 and December 2025 were included. The patients were divided into a robotic-assisted surgery (RAS) group (n = 39) and a laparoscopic-assisted surgery (LAS) group (n = 34). Clinical data, including demographic information, laboratory indexes, surgical data, and prognostic data, were retrospectively reviewed, and the Mann-Whitney U test, independent-samples t-test, and Fisher's exact test were used for statistical analysis. Results: The groups were comparable in terms of age, sex, weight, pre- and postoperative biochemical markers, fasting time, cyst diameter, and operative time. Overall, 80.8% of cases were prenatally detected. The RAS group had a significantly shorter postoperative hospital stay (p = 0.004, Z = -2.864), drainage tube duration (p = 0.002, Z = -3.100), and hepaticojejunostomy time (p < 0.0001, df = 71, 95%CI (-5.70, -3.04)) compared to the LAS group. In the LAS group, three patients developed anastomotic fistulas, all of whom required reoperation, and one patient developed adhesive bowel obstruction, whereas in the RAS group, one patient developed incision infection, one developed cholangitis, one developed adhesive bowel obstruction, and one presented with postoperative liver function abnormalities. The hospitalization cost in the LAS group was significantly lower than that in the RAS group (p < 0.0001, Z = -5.468). Conclusions: In experienced pediatric centers, robotic-assisted resection of choledochal cysts is safe and effective for infants aged less than 3 months and deserves further exploration.
