Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review

Abstract

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3^rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3 (0.3-15.9) years; the male-to-female ratio was 1:3.5 (19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9% (79/86). The average total operation time was 426 (180-520) min, the operation time on the machine was 302 (120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of robotic-assisted choledochocystectomy was 8.8 d. Eight patients had biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.

Keywords: Choledochocystectomy; Congenital choledochal cysts; Pediatrics; Robotic surgery.

Figure 1

Preoperation images. Magnetic resonance cholangiopancreatography, euglycemic hyperinsulinemic clamp technique and 3D reconstruction. A: Preoperation MRCP shows type IVa CCs; B: Preoperation EHCT shows CCs involves intrahepatic bile duct; C: Liver and CCs 3D view from front; D: Liver and CCs 3D view from middle hepatic vein (MHV); E: Liver and CCs 3D view from front without vessels; F: Liver and CCs 3D view from middle hepatic vein (MHV) without vessels. CCS: Congenital choledochal cysts.

Figure 2

Postoperation images. C: Camera port; A1/2/3: Arm 1/2/3 port; Assist: Assistant/accessory port.