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Robotic-assisted Kasai portoenterostomy for biliary atresia

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Abstract

Background

Robotic-assisted Kasai portoenterostomy (RAKPE) has been utilized to treat biliary atresia (BA). However, RAKPE is not widely performed and its efficacy remains unknown. We summarized the experience of RAKPE for BA and determined its efficacy.

Materials and methods

We retrospectively analyzed 25 consecutive infants with non-syndromic type III BA who received RAKPE in our center from January 2020 to July 2021. RAKPE is a three-arm setup and four-trocar operation. Bipolar coagulation was used to dissect the small blood vessels at the hepatic portal. The fibrous cone was shallowly transected with bending electric scissors, followed by gelatin sponge compression to staunch the hemorrhage. Finally, a wide anastomosis was accurately constructed. Demographics and outcomes were recorded.

Results

The mean operative time was 211.64 ± 18.93 min. No conversion to laparotomy or intraoperative complications occurred. The mean estimated blood loss was 7.64 ± 2.43 mL. Enteral feeding was resumed after 3.44 ± 1.23 days. All patients achieved bile excretion postoperatively, and dark green bile-stained stools were passed 1.50 days (range 1.00–3.00 days) after surgery. The average postoperative length of hospital stay was 10.32 ± 2.59 days. The jaundice clearance (JC) rate was 76.00% within 6 months after surgery and the incidence of cholangitis was 48.00% within 1 year following surgery. The survival with native liver (SNL) rate was 80.00% at 1 year and 66.67% at 2 years.

Conclusion

RAKPE can be regarded as a treatment option for patients with BA due to the good outcomes reported. However, long-term studies comparing open or laparoscopic approaches are needed.

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Acknowledgements

We would like to acknowledge Professor Patrick Chung for writing assistance.

Funding

National Natural Science Foundation of China (Grant Numbers 81873848 and 82071689).

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Author notes

  1. Mengxin Zhang, Guoqing Cao, and Xiangyang Li contributed equally to this study.

Authors and Affiliations

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

    Mengxin Zhang, Guoqing Cao, Xiangyang Li, Xi Zhang, Yibo Li, Shuiqing Chi, Liying Rong & Shao-tao Tang

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  1. Mengxin Zhang
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Mengxin Zhang, Guo-qing Cao, Xiangyang Li, Xi Zhang, Yibo Li, Shuiqing Chi, Liying Rong, Shao-Tao Tang have no conflicts of interest or financial ties to disclose.

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Zhang, M., Cao, G., Li, X. et al. Robotic-assisted Kasai portoenterostomy for biliary atresia. Surg Endosc 37, 3540–3547 (2023). https://doi.org/10.1007/s00464-022-09855-x

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