Comparison of robotic assistance and laparoscopy for pediatric choledochal cyst: advantages of robotic assistance
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In brief
In brief
This comparative study demonstrates robotic-assisted surgery's advantages over laparoscopy for pediatric choledochal cyst excision and hepaticojejunostomy. Robotic assistance achieved faster dissection, shorter anastomotic times, lower postoperative amylase levels, quicker recovery, and zero complications versus 25.8% complication rate with laparoscopy alone.
Written by the GCMD Library team from the article.
Abstract
Aim
Surgery for pediatric choledochal cyst (CC), complete excision (CE), and Roux-en-Y hepaticojejunostomy anastomosis (HJA) can be performed using laparoscopy (Lap), robotic-assistance (Rob; da Vinci Xi/Si), or both (Lap/Rob).
Methods
Lap was used exclusively between 2009 and 2021 (n = 31) and Rob was introduced in 2017 (n = 23). All subjects were matched for age, weight, BMI, and episodes of preoperative pancreatitis. For Rob, the first 15/23 were Lap-CE/Rob-HJA and the last 8/23 were Rob-CE/Rob-HJA.
Results
Total anastomotic time (TAT), TAT per suture during HJA, and time taken for dissection during CE were significantly shorter with less variance for Rob, although overall operative times were similar. Serum amylase on postoperative days 3, 5, and 7 were significantly higher for Lap. Times taken to ambulate, for return of bowel sounds, and discharge home were all significantly shorter for Rob. All postoperative complications occurred after Lap; HJA leak (n = 1; 3.2%), HJA stricture (n = 1; 3.2%), both treated by open re-HJA; and pancreatic fistula (n = 6; 19%), all treated conservatively.
Conclusion
Dissection and recovery were faster with Rob while overcoming Lap-associated shortcomings to prevent complications associated with suturing. Both CE and HJA were safer and more reliable with Rob, a reflection of Rob’s superiority.