Safety and efficacy of robot-assisted bile ductoplasty and intrapancreatic bile duct resection in congenital biliary dilatation: a single-center retrospective cohort (2013-2024).

Robot-assisted surgery is increasingly being utilized for congenital biliary dilatation (CBD); however, limited data exist on its feasibility across age groups, particularly for bile ductoplasty and intrapancreatic bile duct (IPBD) resection. This was a retrospective cohort study that compared the outcomes of robot-assisted versus laparoscopic CBD surgery in 159 patients (Rob group: 57; Lap group: 102) treated between 2013 and 2024. In the Rob group, hospital stay was significantly shorter, enteral feeding was started earlier, and drain duration was reduced, especially in pediatric patients. Late complications (e.g., cholangitis) were significantly less common in the Rob group compared to the Lap group (3.5 vs. 18%). The length of residual IPBD was similar in both groups. Furthermore, robotic procedures facilitate a secure and accurate hilar bile ductoplasty, thereby contributing to favorable outcomes without anastomotic stenosis or hepatolithiasis. While these findings support the potential advantages of robot-assisted CBD surgery, the follow-up period was significantly shorter in the Rob group than in the Lap group, and thus definitive conclusions regarding long-term outcomes cannot yet be drawn. Robot-assisted surgery appears safe and is associated with faster short-term recovery; long-term comparative effectiveness requires longer follow-up and adjusted analyses.