Da Vinci robot assisted choledochal cyst resection in children: experience sharing of 200 cases in a single center_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZOU Guoyou ^1,2 , XIANG Bo ¹ , XIE Xiaolong ¹ ,  LI Kewei ¹

1. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lhasa 850010, P. R. China;

Corresponding author：

LI Kewei, Email: vivivan5225133@outlook.com

Keywords：

biliary dilatation; Da Vinci robot; surgery; child

DOI：

10.7507/1007-9424.202208088

Video：

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Objective To explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. Method The data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. Results A total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. Conclusions From the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.

Citation： ZOU Guoyou, XIANG Bo, XIE Xiaolong, LI Kewei. Da Vinci robot assisted choledochal cyst resection in children: experience sharing of 200 cases in a single center. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 30-35. doi: 10.7507/1007-9424.202208088 Copy

1.	Olbourne NA. Choledochal cysts. A review of the cystic anomalies of the biliary tree. Ann R Coll Surg Engl, 1975, 56(1): 26-32.
2.	Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc, 2002, 55(7): 889-896.
3.	Yamaguchi M. Congenital choledochal cyst. Analysis of 1 433 patients in the Japanese literature. Am J Surg, 1980, 140(5): 653-657.
4.	Lee HK, Park SJ, Yi BH, et al. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol, 2009, 10(1): 71-80.
5.	Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg, 2009, 52(5): 434-440.
6.	Wiseman K, Buczkowski AK, Chung SW, et al. Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. Am J Surg, 2005, 189(5): 527-531.
7.	Farello GA, Cerofolini A, Rebonato M, et al. Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc, 1995, 5(5): 354-358.
8.	施佳, 张旻中, 邢莉莉, 等. 腹腔镜下手术治疗先天性胆总管囊肿198例分析. 临床小儿外科杂志, 2016, 15(3): 250-253.
9.	Woo R, Le D, Albanese CT, et al. Robot-assisted laparoscopic resection of a type Ⅰ choledochal cyst in a child. J Laparoendosc Adv Surg Tech A, 2006, 16(2): 179-183.
10.	Dawrant MJ, Najmaldin AS, Alizai NK. Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg, 2010, 45(12): 2364-2368.
11.	谢钧韬, 李作青, 陈华东, 等. 达芬奇机器人手术治疗儿童胆总管囊肿的初步报告. 中华小儿外科杂志, 2018, 39(3): 200-203.
12.	de Vries JS, de Vries S, Aronson DC, et al. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification. J Pediatr Surg, 2002, 37(11): 1568-1573.
13.	Lee SC, Kim HY, Jung SE, et al. Is excision of a choledochal cyst in the neonatal period necessary? J Pediatr Surg, 2006, 41(12): 1984-1986.
14.	Foo DC, Wong KK, Lan LC, et al. Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision. J Paediatr Child Health, 2009, 45(1-2): 28-30.
15.	Miyano T, Yamataka A, Kato Y, et al. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg, 1996, 31(10): 1417-1421.
16.	Stringer MD. Wide hilar hepaticojejunostomy: the optimum method of reconstruction after choledochal cyst excision. Pediatr Surg Int, 2007, 23(6): 529-532.
17.	Sun R, Zhao N, Zhao K, et al. Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: a systematic review and update meta-analysis. PLoS One, 2020, 15(9): e0239857. doi: 10.1371/journal.pone.0239857.
18.	Wang XQ, Xu SJ, Wang Z, et al. Robotic-assisted surgery for pediatric choledochal cyst: case report and literature review. World J Clin Cases, 2018, 6(7): 143-149.
19.	Xie X, Li K, Wang J, et al. Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study. Surg Endosc, 2020, 34(7): 3223-3231.
20.	Xie X, Feng L, Li K, et al. Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases. Surg Endosc, 2021, 35(6): 2690-2697.
21.	Xie X, Li Y, Li K, et al. Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics: Report of 10 cases. J Pediatr Surg, 2021, 56(3): 553-558.
22.	Xie X, Wu Y, Li K, et al. Preliminary experiences with robot-assisted choledochal cyst excision using the Da Vinci surgical system in children below the age of one. Front Pediatr, 2021, 9: 741098. doi: 10.3389/fped.2021.741098.
23.	Ohuchida K, Hashizume M. Robotic surgery for cancer. Cancer J, 2013, 19(2): 130-132.
24.	Herron DM, Marohn M; SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc, 2008, 22(2): 313-325.
25.	Yang GZ, Kerr K, Darzi A. A special issue on selected papers from the 5th Hamlyn Symposium on Medical Robotics, 2012. J Robot Surg, 2013, 7(3): 215. doi: 10.1007/s11701-013-0425-0.
26.	Narasimhan KL, Chowdhary SK, Rao KL. Management of accessory hepatic ducts in choledochal cysts. J Pediatr Surg, 2001, 36(7): 1092-1093.
27.	Yoon JH, Hwang HK, Lee WJ, et al. Minimally invasive surgery for choledochal cysts: laparoscopic versus robotic approaches. Ann Hepatobiliary Pancreat Surg, 2021, 25(1): 71-77.
28.	Todani T, Watanabe Y, Urushihara N, et al. Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg, 1995, 30(3): 478-481.
29.	Diao M, Li L, Zhang JZ, et al. A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study. J Pediatr Surg, 2010, 45(4): 845-847.

1. Olbourne NA. Choledochal cysts. A review of the cystic anomalies of the biliary tree. Ann R Coll Surg Engl, 1975, 56(1): 26-32.
2. Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc, 2002, 55(7): 889-896.
3. Yamaguchi M. Congenital choledochal cyst. Analysis of 1 433 patients in the Japanese literature. Am J Surg, 1980, 140(5): 653-657.
4. Lee HK, Park SJ, Yi BH, et al. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol, 2009, 10(1): 71-80.
5. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg, 2009, 52(5): 434-440.
6. Wiseman K, Buczkowski AK, Chung SW, et al. Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. Am J Surg, 2005, 189(5): 527-531.
7. Farello GA, Cerofolini A, Rebonato M, et al. Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc, 1995, 5(5): 354-358.
8. 施佳, 张旻中, 邢莉莉, 等. 腹腔镜下手术治疗先天性胆总管囊肿198例分析. 临床小儿外科杂志, 2016, 15(3): 250-253.
9. Woo R, Le D, Albanese CT, et al. Robot-assisted laparoscopic resection of a type Ⅰ choledochal cyst in a child. J Laparoendosc Adv Surg Tech A, 2006, 16(2): 179-183.
10. Dawrant MJ, Najmaldin AS, Alizai NK. Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg, 2010, 45(12): 2364-2368.
11. 谢钧韬, 李作青, 陈华东, 等. 达芬奇机器人手术治疗儿童胆总管囊肿的初步报告. 中华小儿外科杂志, 2018, 39(3): 200-203.
12. de Vries JS, de Vries S, Aronson DC, et al. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification. J Pediatr Surg, 2002, 37(11): 1568-1573.
13. Lee SC, Kim HY, Jung SE, et al. Is excision of a choledochal cyst in the neonatal period necessary? J Pediatr Surg, 2006, 41(12): 1984-1986.
14. Foo DC, Wong KK, Lan LC, et al. Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision. J Paediatr Child Health, 2009, 45(1-2): 28-30.
15. Miyano T, Yamataka A, Kato Y, et al. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg, 1996, 31(10): 1417-1421.
16. Stringer MD. Wide hilar hepaticojejunostomy: the optimum method of reconstruction after choledochal cyst excision. Pediatr Surg Int, 2007, 23(6): 529-532.
17. Sun R, Zhao N, Zhao K, et al. Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: a systematic review and update meta-analysis. PLoS One, 2020, 15(9): e0239857. doi: 10.1371/journal.pone.0239857.
18. Wang XQ, Xu SJ, Wang Z, et al. Robotic-assisted surgery for pediatric choledochal cyst: case report and literature review. World J Clin Cases, 2018, 6(7): 143-149.
19. Xie X, Li K, Wang J, et al. Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study. Surg Endosc, 2020, 34(7): 3223-3231.
20. Xie X, Feng L, Li K, et al. Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases. Surg Endosc, 2021, 35(6): 2690-2697.
21. Xie X, Li Y, Li K, et al. Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics: Report of 10 cases. J Pediatr Surg, 2021, 56(3): 553-558.
22. Xie X, Wu Y, Li K, et al. Preliminary experiences with robot-assisted choledochal cyst excision using the Da Vinci surgical system in children below the age of one. Front Pediatr, 2021, 9: 741098. doi: 10.3389/fped.2021.741098.
23. Ohuchida K, Hashizume M. Robotic surgery for cancer. Cancer J, 2013, 19(2): 130-132.
24. Herron DM, Marohn M; SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc, 2008, 22(2): 313-325.
25. Yang GZ, Kerr K, Darzi A. A special issue on selected papers from the 5th Hamlyn Symposium on Medical Robotics, 2012. J Robot Surg, 2013, 7(3): 215. doi: 10.1007/s11701-013-0425-0.
26. Narasimhan KL, Chowdhary SK, Rao KL. Management of accessory hepatic ducts in choledochal cysts. J Pediatr Surg, 2001, 36(7): 1092-1093.
27. Yoon JH, Hwang HK, Lee WJ, et al. Minimally invasive surgery for choledochal cysts: laparoscopic versus robotic approaches. Ann Hepatobiliary Pancreat Surg, 2021, 25(1): 71-77.
28. Todani T, Watanabe Y, Urushihara N, et al. Biliary complications after excisional procedure for choledochal cyst. J Pediatr Surg, 1995, 30(3): 478-481.
29. Diao M, Li L, Zhang JZ, et al. A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study. J Pediatr Surg, 2010, 45(4): 845-847.

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Da Vinci robot assisted choledochal cyst resection in children: experience sharing of 200 cases in a single center

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