Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study

Background The main treatment of choledochal cysts is the complete resection of the cyst with Roux-en-Y hepaticojejunostomy, which includes open procedures, laparoscopic procedures, and robot-assisted procedures using a da Vinci surgical system. The aim of this current study was to investigate the safety and effectiveness of these three different surgical methods in pediatric choledochal cyst excisions. Methods Between January 2015 and December 2018, patients with choledochal cysts treated with open procedures, laparoscopic procedures, or robot-assisted procedures were retrospectively analyzed. The data collected included demographic information of all patients, type and size of cyst, operative details, and postoperative outcomes. Results A total of 371 episodes of patients were enrolled which consist of the open procedures group (n = 226), laparoscopic procedures group (n = 104), and robot-assisted procedures group (n = 41). The operation time was significantly longer in the laparoscopic procedures group (212.79 +/- 34.94) than open procedures group (115.88 +/- 13.50) and robot-assisted procedures group (180.61 +/- 14.07) (p < 0.001). The volume of intraoperative bleeding were higher in the open procedures group (40.12 +/- 55.51) than in the laparoscopic procedures group (21.73 +/- 11.44) and robot-assisted procedures group (21.34 +/- 9.42), while there was no significant difference between the latter groups. The time to taking water, time to starting liquid diet, and the average length of postoperative hospital stay were similar between the laparoscopic and robot-assisted procedures group, which are shorter than the open procedures group with significant differences. There was no signifcant difference in complications among the three groups. Conclusion Choledochal cyst excision with robotic-assisted procedures had identical surgical effects as open procedures and had lower technical requirements. But it had higher medical cost and better cosmetic effects. Open procedures had largely positive surgical outcomes with fewest complications but poor cosmetic effects. Laparoscopic procedures were the most technique-demanding approaches with positive cosmetic and economic effect. The incidence of complications of laparoscopic procedures decreased with the learning curve.