Robotic-assisted choledochal cyst surgery in infants: are we operating too early?

Zhang et al. report the largest single-center experience of robotic-assisted choledochal cyst resection in children, including a substantial proportion of infants. However, the indications for surgery in neonates and young infants remain unclear, particularly in the absence of data on symptomatic status. Early surgery involves technical challenges and may carry a higher risk of anastomotic stricture, potentially underestimated given limited follow-up. Emerging evidence supports delaying intervention in asymptomatic patients, allowing growth and risk stratification. Furthermore, the risk of malignant transformation is negligible in infancy. While robotic surgery is a valuable advancement, its availability should not determine timing of intervention without clear clinical justification.