Skip to main content
SpringerLink
Log in

Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Little data are available to assess the learning curve for robot-assisted surgery on choledochal cysts. The aim of this current study is to investigate the characteristics of the learning curve for robot-assisted choledochal cyst excisions using the da Vinci (SI) surgical system in pediatrics.

Methods

A retrospectively collected database comprising all medical records of the first 60 consecutive patients undergoing a robot-assisted choledochal cyst excision and Roux-en-Y hepaticojejunostomy using the da Vinci (SI) surgical system performed by one individual surgeon was studied. Baseline information and postoperative outcomes were collected and then learning curves were analyzed using the cumulative sum (CUSUM) method. Patients were divided into two groups including group A and group B according to the cutoff points of the learning curve. Intraoperative characteristics and short-term outcomes were compared between the two groups.

Results

CUSUM plots revealed that the cutoff point of the learning curve was 14 cases. Comparison of the operative time between the two groups revealed that the total operative time (203.71 ± 15.27, 171.28 ± 3.62 min, P < 0.001), docking time (23.79 ± 5.81, 14.50 ± 0.98 min, P < 0.001), and console time (151.86 ± 9.77, 129.15 ± 2.96 min, P < 0.001) were decreased significantly. The intraoperative bleeding (20.36 ± 7.46 vs. 20.43 ± 9.18, P = 0.977), time to taking water (2.89 ± 0.22 vs. 3.04 ± 0.34, P = 0.115), time to starting solids diet (3.73 ± 0.17 vs. 3.79 ± 0.26, P = 0.387), hospital stay (7.51 ± 1.12 vs. 7.54 ± 0.95, P = 0.910), and the postoperative complications did not differ significantly between the two groups.

Conclusions

The learning curve for the robot-assisted choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children is 14 cases. This learning curve can be used as the basis for performance guidance during training in future.

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. Olbourne NA (1975) Choledochal cysts. A review of the cystic anomalies of the biliary tree. Ann R Coll Surg Engl 56:26–32

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Howell CG, Templeton JM, Weiner S, Glassman M, Betts JM, Witzleben CL (1983) Antenatal diagnosis and early surgery for choledochal cyst. J Pediatr Surg 18:387–393

    Article  CAS  PubMed  Google Scholar 

  3. Stringer MD, Dhawan A, Davenport M, Mieli-Vergani G, Mowat AP, Howard ER (1995) Choledochal cysts: lessons from a 20 year experience. Arch Dis Child 73:528–531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kim HJ, Kim MH, Lee SK, Seo DW, Kim YT, Lee DK, Song SY, Roe IH, Kim JH, Chung JB, Kim CD, Shim CS, Yoon YB, Yang US, Kang JK, Min YI (2002) Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc 55:889–896

    Article  PubMed  Google Scholar 

  5. Yamaguchi M (1980) Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 140:653–657

    Article  CAS  PubMed  Google Scholar 

  6. Dawrant MJ, Najmaldin AS, Alizai NK (2010) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg 45:2364–2368

    Article  PubMed  Google Scholar 

  7. Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 52(5):434–440

    PubMed  PubMed Central  Google Scholar 

  8. Wiseman K, Buczkowski AK, Chung SW, Francoeur J, Schaeffer D, Scudamore CH (2005) Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. Am J Surg 189(5):527–531

    Article  PubMed  Google Scholar 

  9. de Vries JS, de Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A (2002) Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classifcation. J Pediatr Surg 37:1568–1573

    Article  PubMed  Google Scholar 

  10. Ishibashi H, Shimada M, Kamisawa T, Fujii H, Hamada Y, Kubota M, Urushihara N, Endo I, Nio M, Taguchi T, Ando H (2017) Japanese Study Group on Congenital Biliary Dilatation (JSCBD). Japanese clinical practice guidelines for congenital biliary dilatation. J Hepatobiliary Pancreat Sci 24:1–16

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  12. 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 31:529–534

    Article  PubMed  Google Scholar 

  13. Jang JY, Yoon YS, Kang MJ, Kwon W, Park JW, Chang YR, Ahn YJ, Cho JY, Han HS, Kim SW (2013) Laparoscopic excision of a choledochal cyst in 82 consecutive patients. Surg Endosc 27:1648–1652

    Article  PubMed  Google Scholar 

  14. Diao M, Li L, Cheng W (2013) Role of laparoscopy in treatment of choledochal cysts in children. Pediatr Surg Int 29:317–326

    Article  PubMed  Google Scholar 

  15. Wang B, Feng Q, Mao JX, Liu L, Wong KK (2012) Early experience with laparoscopic excision of choledochal cyst in 41 children. J Pediatr Surg 47:2175–2178

    Article  PubMed  Google Scholar 

  16. 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 31(2):778–787

    Article  PubMed  Google Scholar 

  17. Meehan JJ, Elliott S, Sandler A (2007) The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 42:2110–2114

    Article  PubMed  Google Scholar 

  18. 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 Technol A 16:179–183

    Article  Google Scholar 

  19. Alizai NK, Dawrant MJ, Najmaldin AS (2014) Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children. Pediatr Surg Int 30:291–294

    Article  PubMed  Google Scholar 

  20. Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K (2014) Measuring the surgical 'learning curve': methods, variables and competency. Br J Urol Int 113(3):504–508

    Article  Google Scholar 

  21. Ramsay CR, Wallace SA, Garthwaite PH, Monk AF, Russell IT, Grant AM (2002) Assessing the learning curve effect in health technologies Lessons from the nonclinical literature. Int J Technol Assess Health Care 18(1):1–10

    PubMed  Google Scholar 

  22. McCulloch P, Taylor I, Sasako M, Lovett B, Griffin D (2002) Randomised trials in surgery: problems and possible solutions. BMJ 324:1448–1451

    Article  PubMed  PubMed Central  Google Scholar 

  23. Page ES (1954) Continuous inspection schemes. Biometrika 41:100–115

    Article  Google Scholar 

  24. Chaput de Saintonge DM, Vere DW (1974) Why don’t doctors use CUSUMs? Lancet 1:120–121

    Article  CAS  PubMed  Google Scholar 

  25. Wohl H (1977) The CUSUM plot: its utility in the analysis of clinical data. N Engl J Med 296:1044–1045

    Article  CAS  PubMed  Google Scholar 

  26. Jimenez-Rodriguez RM, Diaz-Pavon JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28:815–821

    Article  PubMed  Google Scholar 

  27. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860

    Article  PubMed  Google Scholar 

  29. 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 56(3):737–743

    Article  PubMed  PubMed Central  Google Scholar 

  30. She WH, Chung HY, Lan LC, Wong KK, Saing H, Tam PK (2009) Management of choledochal cyst: 30 years of experience and results in a single center. J Pediatr Surg 44(12):2307–2311

    Article  PubMed  Google Scholar 

  31. Yamataka A, Ohshiro K, Okada Y, Hosoda Y, Fujiwara T, Kohno S, Sunagawa M, Futagawa S, Sakakibara N, Miyano T (1997) Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults. J Pediatr Surg 32(7):1097–1102

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Xiaolong Xie and Liwei Feng are co-first author.

Authors and Affiliations

  1. Department of Pediatric Surgery, West China hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan, China

    Xiaolong Xie, Liwei Feng, Kewei Li, Chuan Wang & Bo Xiang

Authors
  1. Xiaolong Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liwei Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kewei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bo Xiang.

Ethics declarations

Disclosures

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Xiaolong Xie, Liwei Feng, Kewei Li, Chuan Wang, and Bo Xiang 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

Xie, X., Feng, L., Li, K. et al. Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases. Surg Endosc 35, 2690–2697 (2021). https://doi.org/10.1007/s00464-020-07695-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07695-1

Keywords

Search

Navigation