Skip to main content
SpringerLink
Log in

Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children: a systematic review and proportional meta-analysis

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Most commonly, cyst excision and Roux-en-Y hepaticojejunostomy reconstruction are the optimal treatment for choledochal cysts (CC). Robotic surgery (RS) is being conducted with increasing frequency to treat CC. It is unclear whether RS can overcome the limitations of laparoscopic surgery (LS) and improve the prognosis of patients. In terms of efficacy, evidence concerning which minimally invasive surgery is preferred is, however, sparse. Our objective is to further compare the efficacy of RS and LS in children with CC and draw a useful clinical conclusion.

Methods

Studies meeting inclusion criteria were identified from a series of databases, consisting of PubMed, Embase, Scopus, Web of Science, the Cochrane Library and their reference list of articles up to May 2022. Eligible articles comprised at least five objects that were younger than 18 years of age and the language was limited to English. Two authors independently evaluated selected studies and extracted data for analysis.

Results

Forty studies were selected for analysis, with thirty-six reporting data on LS and eight containing data on RS. The pooled conversion rate and pooled postoperative complication rate of RS were lower than those of LS, but none of them was statistically significant. Moreover, comparisons of the following detailed postoperative complication rates were not statistically significant, such as intestinal obstruction or ileus, anastomotic bleeding, anastomotic or bile leakage, and anastomotic stenosis. However, the intraoperative blood loss and the postoperative hospital stay in RS group were significantly lower than those in LS group.

Conclusions

RS is a safe and feasible option for children with CC. Further studies with more cases, long-term efficacy and health economics analysis are needed to confirm whether RS is more advantageous.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Farello GA, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A (1995) Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 5(5):354–358

    CAS  Google Scholar 

  2. Diao M, Li L, Li Q, Ye M, Cheng W (2013) Single-incision versus conventional laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts: a case-control study. World J Surg. https://doi.org/10.1007/s00268-013-2012-y

    Article  Google Scholar 

  3. Laje P, Questa H, Bailez M (2007) Laparoscopic leak-free technique for the treatment of choledochal cysts. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2006.0121

    Article  Google Scholar 

  4. Tang Y, Li F, He G (2016) Comparison of single-incision and conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for children with choledochal cysts. Indian J Surg. https://doi.org/10.1007/s12262-015-1348-y

    Article  Google Scholar 

  5. Son TN, Liem NT, Hoan VX (2014) Transumbilical laparoendoscopic single-site surgery with conventional instruments for choledochal cyst in children: early results of 86 cases. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2014.0268

    Article  Google Scholar 

  6. Qu X, Cui L, Xu J (2019) Laparoscopic surgery in the treatment of children with choledochal cyst. Pak J Med Sci. https://doi.org/10.12669/pjms.35.3.85

    Article  Google Scholar 

  7. Song G, Jiang X, Wang J, Li A (2017) Comparative clinical study of laparoscopic and open surgery in children with choledochal cysts. Saudi Med J. https://doi.org/10.15537/smj.2017.5.17667

    Article  Google Scholar 

  8. Paganoti GF, Barros F, Bueno MAG, Guimaraes GC, Vieira AM, Costa CL, Apezzato MLP (2012) Robotic pediatric surgery: early experience in Brazil. J Pediat Surg Case R. https://doi.org/10.1016/j.epsc.2020.101659

    Article  Google Scholar 

  9. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. https://doi.org/10.1097/SLA.0000000000001413

    Article  Google Scholar 

  10. Woo R, Le D, Albanese CT, Kim SS (2006) Robot-assisted laparoscopic resection of a type I choledochal cyst in a child. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2006.16.179

    Article  Google Scholar 

  11. Goh BKP, Low TY, Teo JY, Lee SY, Chan CY, Chung AYF, Ooi LLPJ (2019) Initial single institution experience with robotic biliary surgery and bilio-enteric anastomosis in Southeast Asia. ANZ J Surg. https://doi.org/10.1111/ans.15135

    Article  Google Scholar 

  12. Dawrant MJ, Najmaldin AS, Alizai NK (2010) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2010.08.031

    Article  Google Scholar 

  13. Chang EY, Hong YJ, Chang HK, Oh JT, Han SJ (2012) Lessons and tips from the experience of pediatric robotic choledochal cyst resection. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2011.0503

    Article  Google Scholar 

  14. Faust RA (2008) Paradigm shift in pediatric surgery: invasion of the robots. Clin Pediatr (Phila). https://doi.org/10.1177/0009922807307152

    Article  Google Scholar 

  15. Kim NY, Chang EY, Hong YJ, Park S, Kim HY, Bai SJ, Han SJ (2015) Retrospective assessment of the validity of robotic surgery in comparison to open surgery for pediatric choledochal cyst. Yonsei Med J. https://doi.org/10.3349/ymj.2015.56.3.737

    Article  Google Scholar 

  16. Naitoh T, Morikawa T, Tanaka N, Aoki T, Ohtsuka H, Okada T, Sakata N, Ohnuma S, Nakagawa K, Hayashi H, Musha H, Yoshida H, Motoi F, Katayose Y, Unno M (2015) Early experience of robotic surgery for type I congenital dilatation of the bile duct. J Robot Surg. https://doi.org/10.1007/s11701-015-0504-5

    Article  Google Scholar 

  17. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA; PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. https://doi.org/10.1186/2046-4053-4-1

    Article  Google Scholar 

  18. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  Google Scholar 

  19. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. https://doi.org/10.1016/j.cct.2006.04.004

    Article  Google Scholar 

  20. El Dib R, Touma NJ, Kapoor A (2012) Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int. https://doi.org/10.1111/j.1464-410X.2011.10885.x

    Article  Google Scholar 

  21. El Dib R, Nascimento Junior P, Kapoor A (2013) An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies. Acta Cir Bras. https://doi.org/10.1590/s0102-86502013001200010

    Article  Google Scholar 

  22. Senthilnathan P, Patel ND, Nair AS, Nalankilli VP, Vijay A, Palanivelu C (2015) Laparoscopic management of choledochal cyst-technical modifications and outcome analysis. World J Surg. https://doi.org/10.1007/s00268-015-3111-8

    Article  Google Scholar 

  23. Bismuth H, Krissat J (1999) Choledochal cystic malignancies. Ann Oncol 4:94–98

    Article  Google Scholar 

  24. Shen HJ, Xu M, Zhu HY, Yang C, Li F, Li KW, Shi WJ, Ji F (2015) Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis. Pediatr Surg Int. https://doi.org/10.1007/s00383-015-3705-0

    Article  Google Scholar 

  25. Zhen C, Xia Z, Long L, Lishuang M, Pu Y, Wenjuan Z, Xiaofan L (2015) Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis. Int Surg. https://doi.org/10.9738/INTSURG-D-14-00165.1

    Article  Google Scholar 

  26. Sun R, Zhao N, Zhao K, Su Z, Zhang Y, Diao M, Li L (2020) Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: a systematic review and update meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0239857

    Article  Google Scholar 

  27. Koga H, Murakami H, Ochi T, Miyano G, Lane GJ, Yamataka A (2019) Comparison of robotic versus laparoscopic hepaticojejunostomy for choledochal cyst in children: a first report. Pediatr Surg Int. https://doi.org/10.1007/s00383-019-04565-3

    Article  Google Scholar 

  28. Nazki S, Kanojia RP, Bawa M, Binu V, Lal S, Sood A, Samujh R (2021) Robotic excision of choledochal cyst with Hepaticoduodenostomy (HD): report of HD technique, initial experience, and early outcome. Eur J Pediatr Surg. https://doi.org/10.1055/s-0040-1713933

    Article  Google Scholar 

  29. Xie X, Li Y, Li K, Wang Q, Xiang B (2021) Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics: Report of 10 cases. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2020.07.01

    Article  Google Scholar 

  30. Pham HD, Okata Y, Vu HM, Tran NX, Nguyen QT, Nguyen LT (2019) Robotic-assisted surgery for choledochal cyst in children: early experience at Vietnam National Children’s Hospital. Pediatr Surg Int. https://doi.org/10.1007/s00383-019-04518-w

    Article  Google Scholar 

  31. Xie X, Li K, Wang J, Wang C, Xiang B (2020) Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study. Surg Endosc. https://doi.org/10.1007/s00464-020-07560-1

    Article  Google Scholar 

  32. Hong L, Wu Y, Yan Z, Xu M, Chu J, Chen QM (2008) Laparoscopic surgery for choledochal cyst in children: a case review of 31 patients. Eur J Pediatr Surg. https://doi.org/10.1055/s-2008-1038486

    Article  Google Scholar 

  33. Xie X, Feng L, Li K, Wang C, Xiang B (2021) Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases. Surg Endosc. https://doi.org/10.1007/s00464-020-07695-1

    Article  Google Scholar 

  34. Alizai NK, Dawrant MJ, Najmaldin AS (2014) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children. Pediatr Surg Int. https://doi.org/10.1007/s00383-013-3459-5

    Article  Google Scholar 

  35. Diao M, Li L, Cheng W (2011) Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results. Surg Endosc. https://doi.org/10.1007/s00464-010-1435-x

    Article  Google Scholar 

  36. Chi SQ, Cao GQ, Li S, Guo JL, Zhang X, Zhou Y, Tang ST (2021) Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children. Surg Endosc. https://doi.org/10.1007/s00464-020-07981-y

    Article  Google Scholar 

  37. Liu F, Xu X, Lan M, Tao B, Li L, Wu Q, Chai C, Zeng J (2020) Total versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in children with choledochal cysts: a case-control study. BMC Surg. https://doi.org/10.1186/s12893-020-00906-5

    Article  Google Scholar 

  38. Wang XQ, Xu SJ, Wang Z, Xiao YH, Xu J, Wang ZD, Chen DX (2018) Robotic-assisted surgery for pediatric choledochal cyst: case report and literature review. World J Clin Cases. https://doi.org/10.12998/wjcc.v6.i7.143

    Article  Google Scholar 

  39. Lin S, Chen J, Tang K, He Y, Xu X, Xu D (2022) Trans-umbilical single-site plus one robotic assisted surgery for choledochal cyst in children, a comparing to laparoscope-assisted procedure. Front Pediatr. https://doi.org/10.3389/fped.2022.806919

    Article  Google Scholar 

  40. Lima M, Gargano T, Ruggeri G, Destro F, Maffi M (2016) Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases. Pediatr Med Chir. https://doi.org/10.4081/pmc.2016.125

    Article  Google Scholar 

  41. Gander JW, Cowles RA, Gross ER, Reichstein AR, Chin A, Zitsman JL, Middlesworth W, Rothenberg SS (2010) Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2010.0123

    Article  Google Scholar 

  42. Martin AD, Nunez RN, Castle EP (2011) Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology. https://doi.org/10.1016/j.urology.2010.07.502

    Article  Google Scholar 

  43. Urushihara N, Fukumoto K, Yamoto M, Miyake H, Takahashi T, Nomura A, Sekioka A, Yamada Y, Nakaya K (2018) Characteristics, management, and outcomes of congenital biliary dilatation in neonates and early infants: a 20-year, single-institution study. J Hepatobiliary Pancreat Sci. https://doi.org/10.1002/jhbp.590

    Article  Google Scholar 

  44. Wen Z, Liang H, Liang J, Liang Q, Xia H (2017) Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon’s experience. Surg Endosc. https://doi.org/10.1007/s00464-016-5032-5

    Article  Google Scholar 

  45. Liuming H, Hongwu Z, Gang L, Jun J, Wenying H, Wong KKY, Miao X, Qizhi Y, Jun Z, Shuli L, Li L (2011) The effect of laparoscopic excision vs open excision in children with choledochal cyst: a midterm follow-up study. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2010.10.012

    Article  Google Scholar 

  46. Zhuansun D, Jiao C, Meng X, Xiao J, He Y, Feng J (2020) A study of three-dimensional versus two-dimensional laparoscopic surgery in resection of congenital choledochal cyst of children and jejunum roux-en-y anastomosis. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2019.0497

    Article  Google Scholar 

  47. Cherqaoui A, Haddad M, Roman C, Gorincour G, Marti JY, Bonnard A, Guys JM, de Lagausie P (2012) Management of choledochal cyst: evolution with antenatal diagnosis and laparoscopic approach. J Minim Access Surg. https://doi.org/10.4103/0972-9941.103113

    Article  Google Scholar 

  48. Lee KH, Tam YH, Yeung CK, Chan KW, Sihoe JD, Cheung ST, Mou JW (2009) Laparoscopic excision of choledochal cysts in children: an intermediate-term report. Pediatr Surg Int. https://doi.org/10.1007/s00383-009-2343-9

    Article  Google Scholar 

  49. Zheng J, Li Z, Ye Y, Wang B (2020) Short-term complications after laparoscopic choledochal cyst radical surgery: prevention and treatment. Front Surg. https://doi.org/10.3389/fsurg.2020.583210

    Article  Google Scholar 

  50. Yeung F, Fung ACH, Chung PHY, Wong KKY (2022) Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc. https://doi.org/10.1007/s00464-019-07004-5

    Article  Google Scholar 

  51. Tang ST, Yang Y, Wang Y, Mao YZ, Li SW, Tong QS, Cao GQ, Zhao ZX (2011) Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases. Surg Endosc. https://doi.org/10.1007/s00464-010-1183-y

    Article  Google Scholar 

  52. Zhang B, Wu D, Fang Y, Bai J, Huang W, Liu M, Chen J, Li L (2019) Early complications after laparoscopic resection of choledochal cyst. Pediatr Surg Int. https://doi.org/10.1007/s00383-019-04489-y

    Article  Google Scholar 

  53. Talini C, DE-Carvalho BCN, Antunes LA, Schulz C, Sabbaga CC, Avilla SGA, Garbers JC, DE-Aguiar LRF, Telles LG, DE-Almeida GC, Amado FAB, SilvaEM, E (2018) Choledochal cyst in the pediatric population: experience of 13 laparoscopic procedures in two years at a single institution. Rev Col Bras Cir. https://doi.org/10.1590/0100-6991e-20181854

    Article  Google Scholar 

  54. Yu BH, Lin F (2016) Clinical effects in resection of congenital choledochal cyst of children and jejunum Roux-Y anastomosis by laparoscope. Eur Rev Med Pharmacol Sci 20:4530–4534

    Google Scholar 

  55. Lee C, Byun J, Ko D, Yang HB, Youn JK, Kim HY (2021) Comparison of long-term biliary complications between open and laparoscopic choledochal cyst excision in children. Ann Surg Treat Res. https://doi.org/10.4174/astr.2021.100.3.186

    Article  Google Scholar 

  56. Ahn SM, Jun JY, Lee WJ, Oh JT, Han SJ, Choi SH, Hwang EH (2009) Laparoscopic total intracorporeal correction of choledochal cyst in pediatric population. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2008.0116

    Article  Google Scholar 

  57. Ryu HS, Lee JY, Kim DY, Kim SC, Namgoong JM (2019) Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates. Ann Surg Treat Res. https://doi.org/10.4174/astr.2019.97.1.21

    Article  Google Scholar 

  58. Xuan NT, Thien HH, Thanh PH, Vu PA, Son NH, Thanh DN, Vinh ND, Hiep PN (2019) Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: a single-institution prospective cohort study. Int Surg J 4:2911–2914

    Google Scholar 

  59. Liem NT, Pham HD, Vu HM (2011) Is the laparoscopic operation as safe as open operation for choledochal cyst in children? J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2010.0375

    Article  Google Scholar 

  60. Chokshi NK, Guner YS, Aranda A, Shin CE, Ford HR, Nguyen NX (2009) Laparoscopic choledochal cyst excision: lessons learned in our experience. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2008.0045

    Article  Google Scholar 

  61. Santore MT, Deans KJ, Behar BJ, Blinman TA, Adzick NS, Flake AW (2011) Laparoscopic hepaticoduodenostomy versus open hepaticoduodenostomy for reconstruction after resection of choledochal cyst. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2010.0478

    Article  Google Scholar 

  62. Dalton BG, Gonzalez KW, Dehmer JJ, Andrews WS, Hendrickson RJ (2016) Transition of techniques to treat choledochal cysts in children. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2015.0123

    Article  Google Scholar 

  63. Ng JL, Salim MT, Low Y (2014) Mid-term outcomes of laparoscopic versus open choledochal cyst excision in a tertiary paediatric hospital. Ann Acad Med Singap 43:220–224

    Article  Google Scholar 

  64. Pandey V, Srivastava V, Panigrahi P, Kumar R, Sharma SP (2021) Modified laparoscopic excision of choledochal cyst: technique and early results. J Indian Assoc Pediatr Surg. https://doi.org/10.4103/jiaps.JIAPS_150_20

    Article  Google Scholar 

  65. Arafa A, Ragab M, Eltagy GH (2022) Laparoscopic hepaticoduodenostomy for choledochal cysts in children <1 year. Afr J Paediatr Surg. https://doi.org/10.4103/ajps.AJPS_164_20

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China

    Meng-xin Zhang, Shui-qing Chi, Guo-qing Cao & Shao-tao Tang

  2. Department of Hepatobiliary Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China

    Jing-feng Tang

Authors
  1. Meng-xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shui-qing Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guo-qing Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing-feng Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shao-tao Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shao-tao Tang.

Ethics declarations

Disclosures

Meng-xin Zhang, Shui-qing Chi, Guo-qing Cao, Jing-feng Tang, Shao-tao Tang have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Mx., Chi, Sq., Cao, Gq. et al. Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children: a systematic review and proportional meta-analysis. Surg Endosc 37, 31–47 (2023). https://doi.org/10.1007/s00464-022-09442-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09442-0

Keywords

Search

Navigation