Comparison of robotic versus laparoscopic cyst excision and hepaticojejunostomy for choledochal cyst in children: a propensity score-matched study.

Abstract

Background: Minimally invasive surgery (MIS) has become a standard approach in pediatric surgery, including for the treatment of choledochal cysts (CC). This study compared the long-term outcomes of laparoscopic (LA) and robot-assisted (RA) surgeries for pediatric CC. Propensity score matching (PSM) was used to control for potential confounding variables that could influence surgical outcomes.

Methods: A retrospective review of 159 pediatric patients who underwent MIS for CC at our tertiary referral center between June 2008 and December 2020 was conducted. PSM was used to minimize selection bias, resulting in 63 matched pairs of patients in the RA and LA groups. Key outcomes, including operative time, complication rates, and post-operative recovery, were compared between the two groups.

Results: After PSM, the RA group had a longer mean operative time compared to the LA group (359 vs. 319 min, p = 0.006). However, the RA group had a significantly lower incidence of anastomotic leaks (0% vs. 7.9%, p = 0.023). There were no statistically significant differences between the groups in terms of conversion to open surgery, length of hospital stay, or severe complications. The RA group had a shorter time to start feeding and to achieve full feeding postoperatively.

Conclusion: RA significantly enhances the quality of anastomosis, contributing to more secure anastomoses compared to LA, and provides the benefit of faster bowel movement recovery in pediatric choledochal cysts.