Comparison of laparoscopic and robotic surgery of choledochal cyst in pediatrics: single center experience

TL;DR

This study compares laparoscopic and robotic surgery for treating choledochal cysts in children, finding both methods effective but with some differences in outcomes.

Contribution

The study provides a single-center comparison of laparoscopic and robotic surgery outcomes for pediatric choledochal cysts.

Findings

Laparoscopic procedures resulted in larger anastomosis sites compared to robotic surgery.

Hospitalization was shorter with robotic surgery, though not all complications were statistically significant.

Robot-assisted surgery showed no complications, while laparoscopy had several reported issues.

Abstract

Recently, laparoscopic and robot-assisted procedures have become increasingly common for treating pediatric choledochal cysts. This retrospective study aims to evaluate and compare the safety and efficacy of these procedures in pediatric choledochal cyst cases.

Between April 2017 and September 2023, 60 patients were enrolled in this study; laparoscopic procedures were applied in 45 patients, and robot-assisted procedures in 15. We collected clinical data, including all patients’ demographic information, the cyst’s type and size, and clinical outcomes through a review of medical records. We also conducted a satisfaction survey using validated questionnaires (Glasgow Children’s Benefit Inventory, Gastrointestinal Quality of Life Index) and additional supplementary questions.

For the anastomosis site size (mm), the laparoscopy group (9.38, [5.09;11.55]) showed larger sizes than the robot-assisted group (7.26, [3.68;8.69]) (p = 0.0381). Hospitalization days (d) were longer for the laparoscopy group (14.64, [9;16]) compared to the robot-assisted group (11.13, [8;12]) (p = 0.0224). Although the complications were not statistically significant, the robot-assisted group had no complications. In contrast, the laparoscopy group reported 2 cases of pancreatitis, 1 case of A-loop syndrome, 1 case of chyle ascites, and 1 case of wound complication.

A total of 17 patients responded to the satisfaction survey (28% response rate).

Robot-assisted surgery is a feasible and effective method for treating pediatric choledochal cysts, and its surgical outcomes are comparable with those of laparoscopic procedures.

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