Da vinci robotic-assisted treatment of pediatric choledochal cyst

Abstract

Objective: To evaluate the advantages and disadvantages of da Vinci robot and laparoscopy in treating pediatric choledochal cysts.

Methods: We retrospectively analyzed clinical data from forty-two children diagnosed with choledochal cysts in our hospital from January 2018 to January 2021. Twenty children underwent da Vinci robotic surgery, and the others underwent traditional laparoscopy. We compared differences in general information and preoperative, intraoperative, and postoperative differences between the two surgical groups.

Results: There was no statistically significant difference in age, gender, weight, type, maximum cyst diameter, preoperative C-reactive protein (CRP) value, postoperative complication rate, and postoperative pain score between the two surgical groups (P > 0.05). The average age of the robot-assisted group was 3.62 ± 0.71 years old (range = 1-12 years). There were nineteen cases of Todani type I, one patients of other types, and the maximum cyst diameter was 35.45 ± 9.32 mm (range = 12-56 mm). In the laparoscopic group, the average age was 3.08 ± 0.82 years old (range = 3-10 years). Twenty-one patients had Todani type I, and one had other types. The maximum cyst diameter was 31.94 ± 8.64 mm (range = 10-82 mm). The robot-assisted group had better abdominal drainage, postoperative CRP value, fasting time, and discharge time than the laparoscopic group (P < 0.05).

Conclusion: Compared with laparoscopy, the da Vinci system has the advantages of less tissue damage, faster recovery, and better healing in the treatment of children with congenital choledochal cysts. With technological advancements and an increased number of experienced surgeons, robotic surgery may become a new trend in surgery.

Keywords: choledochal cyst; da vinci robot; laparoscopy; pediatrics; postoperative care.

Figure 1

(A) location of robotic trocars; (B). Suspension of the ligament teres; (C). Cutting the cyst's anterior wall; (D). Clipping of the narrowest part of the distal end of the cyst; (E). Detection of the common hepatic duct with a “trumpet” shape; (F). Common hepatic duct jejunal anastomosis.