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Robotic-assisted choledochal cyst excision with Roux-en-Y hepaticojejunostomy in children: does age matter?

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Abstract

Background

Robotic-assisted surgery (RAS) is being increasingly used in pediatric choledochal cysts (CCs), but is most commonly performed in older children and adolescents. The outcomes in young infants remain to be explored. The purpose of this study is to compare outcomes in infants aged ≤ 1 year with an older cohort.

Methods

From July 2015 to January 2020, a retrospective study was conducted to evaluate the RAS in patients with CCs at our institution. Patients were divided into two groups (group A ≤ 1 year old and group B > 1 year old). Demographics, intraoperative details, complications, and outcomes were analyzed.

Results

A total of 79 patients were included in the study (28 patients in group A and 51patients in group B). The median age of patients at the surgery in group A was 4.9 months (IQR: 3.1–9.1), compared with 46.8 months (IQR: 28.5–86.5) in group B. Three patients in group A were neonates. No conversion to open surgery was required. No significant differences were found between the two groups including sex, Todani type, or diameter of the cysts. The diameter of the common hepatic duct was smaller in group A (6.0 ± 1.7 vs. 9.0 ± 3.0 mm; p < 0.001). Group A had the longer hepaticojejunostomy time [51(44–58) vs. 42(38–53) min; p = 0.013], while Group B had the longer cyst excision time [43(41–59) vs. 50(43–60) min; p = 0.005]. However, their total operative time and console time were similar. There were no statistical differences in length of hospital stay and complications between the two groups.

Conclusions

Robot-assisted cyst resection and hepaticojejunostomy are feasible and safe in infants ≤ 1 year old. Age cannot be considered an absolute contraindication for robotic surgery in patients with CCs.

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References

  1. 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 16:179–183

    Article  Google Scholar 

  2. 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 35:5009–5014

    Article  Google Scholar 

  3. 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 34:3223–3231

    Article  Google Scholar 

  4. 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 35:1421–1425

    Article  Google Scholar 

  5. Molinaro F, Angotti R, Bindi E, Pellegrino C, Fusi G, Luzzi L, Tosi N, Messina M, Mattioli G (2019) Low weight child: can it be considered a limit of robotic surgery? Experience of two centers. J Laparoendosc Adv Surg Tech A 29:698–702

    Article  Google Scholar 

  6. Chan KW, Lee KH, Tsui SY, Mou JW, Tam YH (2016) Laparoscopic management of antenatally detected choledochal cyst: a 10-year review. Surg Endosc 30:5494–5499

    Article  Google Scholar 

  7. Foo DC, Wong KK, Lan LC, Tam PK (2009) Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision. J Paediatr Child Health 45:28–30

    Article  Google Scholar 

  8. Diao M, Li L, Cheng W (2012) Timing of surgery for prenatally diagnosed asymptomatic choledochal cysts: a prospective randomized study. J Pediatr Surg 47:506–512

    Article  Google Scholar 

  9. Diao M, Li L, Cheng W (2020) Timing of choledochal cyst perforation. Hepatology 71:753–756

    Article  Google Scholar 

  10. 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  Google Scholar 

  11. Xie X, Wu Y, Li K, Ai C, Wang Q, Wang C, Chen J, Xiang B (2021) Preliminary experiences with robot-assisted choledochal cyst excision using the da vinci surgical system in children below the age of one. Front Pediatr 9:741098

    Article  Google Scholar 

  12. Ihn K, Ho IG, Hong YJ, Jeon HJ, Lee D, Han SJ (2022) Changes in outcomes and operative trends with pediatric robot-assisted resection of choledochal cyst. Surg Endosc 36:2697–2704

    Article  Google Scholar 

  13. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K (1977) Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 134(2):263–269

    Article  CAS  Google Scholar 

  14. Chang X, Zhang X, Xiong M, Yang L, Li S, Cao G, Zhou Y, Yang D, Tang ST (2019) Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct. Surg Endosc 33:1998–2007

    Article  Google Scholar 

  15. Esposito C, Masieri L, Castagnetti M, Pelizzo G, De Gennaro M, Lisi G, Cobellis G, Gamba P, Di Benedetto V, Escolino M (2020) Current status of pediatric robot-assisted surgery in Italy: epidemiologic national survey and future directions. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2019.0516

    Article  Google Scholar 

  16. Ballouhey Q, Villemagne T, Cros J, Szwarc C, Braik K, Longis B, Lardy H, Fourcade L (2015) A comparison of robotic surgery in children weighing above and below 15.0 kg: size does not affect surgery success. Surg Endosc 29:2643–2650

    Article  Google Scholar 

  17. Villanueva J, Killian M, Chaudhry R (2019) Robotic urologic surgery in the infant: a review. Curr Urol Rep 20:1–16

    Article  Google Scholar 

  18. 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 31:778–787

    Article  Google Scholar 

  19. Wang DC, Liu ZP, Li ZH, Li DJ, Chen J, Zheng SG, He Y, Bie P, Wang SG (2012) Surgical treatment of congenital biliary duct cyst. BMC Gastroenterol 12:29

    Article  CAS  Google Scholar 

  20. Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32:1636–1655

    Article  Google Scholar 

  21. Wu J, Xiang Y, You G, Liu Z, Lin R, Yao X, Yang Y (2021) An essential technique for modern hepato-pancreato-biliary surgery: minimally invasive biliary reconstruction. Expert Rev Gastroenterol Hepatol 15:243–254

    Article  CAS  Google Scholar 

  22. Aly MYF, Mori Y, Miyasaka Y, Ohtsuka T, Sadakari Y, Nakata K, Oda Y, Shimizu S, Nakamura M (2018) Laparoscopic surgery for congenital biliary dilatation: a single-institution experience. Surg Today 48:44–50

    Article  Google Scholar 

  23. Xia HT, Liu Y, Yang T, Liang B, Wang J, Dong JH (2017) Better long-term outcomes with hilar ductoplasty and a side-to-side Roux-en-Y hepaticojejunostomy. J Surg Res 215:21–27

    Article  Google Scholar 

  24. 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 25:544–549

    Article  Google Scholar 

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Funding

Funding was provided by the National Natural Science Foundation of China with Grant No. 81873848 and No. 82071689.

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Author notes

  1. Liying Rong, Yibo Li, and Jingfeng Tang have contributed equally to this work.

Authors and Affiliations

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

    Liying Rong, Yibo Li, Guoqing Cao, Li Wan, Xiangyang Li, Xi Zhang, Shuiqing Chi & Shaotao Tang

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

    Jingfeng Tang

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  1. Liying Rong
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Correspondence to Shaotao Tang.

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Disclosures

Li-ying Rong, Yi-bo Li, Jing-feng Tang, Guo-qing Cao, Li Wan, Xiang-yang Li, Xi Zhang, Shui-qing Chi, and Shao-tao Tang have no conflicts of interest or financial ties to disclose.

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Rong, L., Li, Y., Tang, J. et al. Robotic-assisted choledochal cyst excision with Roux-en-Y hepaticojejunostomy in children: does age matter?. Surg Endosc 37, 274–281 (2023). https://doi.org/10.1007/s00464-022-09496-0

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