Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children
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and Other Interventional Techniques
Outcomes in robotic versus laparoscopic‑assisted choledochal cyst excision and hepaticojejunostomy in children Shui‑qing Chi1 · Guo‑qing Cao1 · Shuai Li1 · Jia‑ling Guo1 · Xi Zhang1 · Ying Zhou1 · Shao‑tao Tang1 Received: 10 June 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Robotic-assisted surgery (RAS) is becoming more popular because of the excellent performance in anastomosis and knot tying, especially in complex surgical procedures such as hepaticojejunostomy. As for operative time and costs, laparoscopic-assisted surgery (LAS) seem to be more advantageous. To date, there are only limited studies focusing on the comparison between RAS and LAS. This study aims to investigate differences in intraoperative and postoperative outcomes between robotic and laparoscopic approaches. Methods We performed a retrospective case–control study of 140 patients operated via mini-invasive approaches for choledochal cyst (CC) excision and hepaticojejunostomy at the Wuhan Union Hospital from Jun 2014 to Dec 2019. A multivariable logistic regression model for odds to having complications was built. Results The two groups were similar in age, sex, follow-up time, and Todani modification of the Alonso-Lej classification distribution. Patients undergoing RAS had longer overall operative time, shorter cyst excision time, shorter hepaticojejunostomy time, less estimated blood loss, a smaller postoperative high fever rate, shorter postoperative LOS, and a lower postoperative complication rate. Moreover, the intraoperative anatomy structures were more explicit in group RAS, such as the exposure of left or right hepatic duct opening and intrapancreatic bile duct. Multivariable logistic regression showed that longer hepaticojejunostomy time was the only risk factor of postoperative complications. Conclusion Robotic-assisted CC excision and hepaticojejunostomy was associated with better intraoperative and short-term postoperative outcomes when compared to laparoscopic-assisted surgery. Keywords Choledochal cyst · Robotic-assisted surgery · Laparoscopic-assisted surgery · Surgical outcomes · Complications · Hepaticojejunostomy The surgical approach to choledochal cyst excision has largely changed from open laparotomy to mini-invasive surgery in many pediatric centers worldwide [1]. Compared with open surgery, laparoscopic-assisted CC excision and hepaticojejunostomy has been proved to be safe and valid, with a much shorter time of recovery [2–4]. However, the higher technical demand of laparoscopic-assisted hepaticojejunostomy (LAHJ) corresponds to a longer operative time
Shui-qing Chi, Guo-qing Cao and Shuai Li contributed equally to this study.
and learning curve. Besides, the low incidence of CC makes LAHJ a considerable challenge for less experienced surgeons [4, 5]. Robotic-assisted hepaticojejunostomy (RAHJ) was first reported by Woo et al. in 2006 [6]. Thereafter, subsequent reports stated the safety and feasibil
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