Pediatric Surgery International

, Volume 35, Issue 12, pp 1421–1425 | Cite as

Comparison of robotic versus laparoscopic hepaticojejunostomy for choledochal cyst in children: a first report

  • Hiroyuki KogaEmail author
  • Hiroshi Murakami
  • Takanori Ochi
  • Go Miyano
  • Geoffrey J. Lane
  • Atsuyuki Yamataka
Original Article



We compared robotic hepaticojejunostomy anastomosis (RHJA) with laparoscopic hepaticojejunostomy anastomosis (LHJA) in children undergoing complete excision of choledochal cyst.


Difficulty of suturing (DOS) during anastomosis was scored blindly, from intraoperative video recordings, using: 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; and 1 = easy. A panel of fiveindependent surgeons was also asked to compare RHJA with matched LHJA and score + 1 if RHJA appeared superior to LHJA, 0 if RHJA appeared equivalent to LHJA, and − 1 if RHJA appeared inferior to LHJA.


RHJA (n = 10) was performed between 2017 and 2019; LHJA (n = 27) was performed between 2009 and 2018. LHJA cases were matched for age, weight, and anastomosis diameter to RHJA cases. Complete excision was performed laparoscopically in both groups. DOS was lower in RHJA with less variance. The panel all scored RHJA as + 1. Total anastomotic time (TAT) and TAT per suture were significantly shorter for RHJA. Times taken to ambulate and for return of bowel sounds postoperatively were significantly shorter for RHJA. There was one anastomotic leak with LHJA (3.7%) and no anastomotic complications with RHJA.


RHJA is a more stable anastomosis that can be performed quicker, and thus, would appear to be superior to LHJA.


Choledochal cyst Hepaticojejunostomy Robotic surgery Laparoscopic surgery Da vinci 



  1. 1.
    Farello GA, Cerofolini A, Rebonato M et al (1995) Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 5:354–358PubMedGoogle Scholar
  2. 2.
    Akaraviputh T, Trakarnsanga A, Suksamanapun N (2010) Robot-assisted complete excision of choledochal cyst type I, hepaticojejunostomy and extracorporeal Roux-en-y anastomosis: a case report and review literature. World J Surg Oncol 8:87–90CrossRefGoogle Scholar
  3. 3.
    Alizai NK, Dawrant MJ, Najmaldin AS (2014) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children. Pediatr Surg Int 30:291–294CrossRefGoogle Scholar
  4. 4.
    Dawrant MJ, Najmaldin AS, Alizai NK (2010) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg 45:2364–2368CrossRefGoogle Scholar
  5. 5.
    Wang XQ, Xu SJ, Wang Z et al (2018) Robotic-assisted surgery for pediatric choledochal cyst: case report and literature review. World J Clin Cases 6:143–149CrossRefGoogle Scholar
  6. 6.
    Kim NY, Chang EY, Hong YJ et al (2015) Retrospective assessment of the validity of robotic surgery in comparison to open surgery for pediatric choledochal cyst. Yonsei Med J 56:737–743CrossRefGoogle Scholar
  7. 7.
    Koga H, Okawada M, Doi T et al (2015) Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision. Pediatr Surg Int 31:991–994CrossRefGoogle Scholar
  8. 8.
    Yamataka A, Lane GJ, Cazares J (2012) Laparoscopic surgery for biliary atresia and choledochal cyst. Semin Pediatr Surg 21:201–210CrossRefGoogle Scholar
  9. 9.
    Heemskerk J, van Gemert WG, de Vries J et al (2007) Learning curves of robot-assisted laparoscopic surgery compared with conventional laparoscopic surgery: an experimental study evaluating skill acquisition of robot-assisted laparoscopic tasks compared with conventional laparoscopic tasks in inexperienced users. Surg Laparosc Endosc Percutaneous Tech 17:171–174CrossRefGoogle Scholar
  10. 10.
    Markar SR, Karthikesalingam AP, Venkat-Ramen V et al (2011) Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot Comput Assisted Surg 7:393–400CrossRefGoogle Scholar
  11. 11.
    Chang EY, Hong YJ, Chang HK et al (2012) Lessons and tips from the experience of pediatric robotic choledochal cyst resection. J Laparoendosc Adv Surg Tech A 22:609–614CrossRefGoogle Scholar
  12. 12.
    Meehan JJ, Elliott S, Sandler A (2007) The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 42:2110–2114CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hiroyuki Koga
    • 1
    Email author
  • Hiroshi Murakami
    • 1
  • Takanori Ochi
    • 1
  • Go Miyano
    • 1
  • Geoffrey J. Lane
    • 1
  • Atsuyuki Yamataka
    • 1
  1. 1.Department of Pediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyoJapan

Personalised recommendations