Xing GD, Wang XQ, Duan L, Liu G, Wang Z, Xiao YH, Xia Q, Xie HW, Shen Z, Yu ZZ, Huang LM. Robotic-assisted Kasai portoenterostomy for child biliary atresia. World J Gastrointest Surg 2024; 16(12): 3780-3785 [DOI: 10.4240/wjgs.v16.i12.3780]
Corresponding Author of This Article
Liu-Ming Huang, Doctor, Chief Physician, Department of Pediatric, The Seventh Medical Center of PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China. surhlm@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guo-Dong Xing, Xian-Qiang Wang, Lian Duan, Gang Liu, Zheng Wang, Yuan-Hong Xiao, Qiao Xia, Hua-Wei Xie, Zhou Shen, Zhen-Zhu Yu, Liu-Ming Huang, Department of Pediatric, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
Liu-Ming Huang, Department of Emergency Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
Author contributions: Xing GD and Huang LM designed the study; Xing GD, Wang XQ, Duan L and Liu G performed the research; Wang Z, Xiao YH, Xia Q and Xie HW responsible for tables and pictures; Xing GD, Shen Z and Yu ZZ wrote the manuscript.
Supported by Innovation and Cultivation Fund Project of the Seventh Medical Center, PLA General Hospital, No. QZX-2023-7.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of PLA General Hospital.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liu-Ming Huang, Doctor, Chief Physician, Department of Pediatric, The Seventh Medical Center of PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China. surhlm@163.com
Received: August 28, 2024 Revised: September 24, 2024 Accepted: October 22, 2024 Published online: December 27, 2024 Processing time: 91 Days and 1.7 Hours
Abstract
BACKGROUND
The Kasai procedure (KPE) is an important treatment for biliary atresia (BA), the most common cause of neonatal obstructive jaundice.
AIM
To investigate the efficacy of robotic-assisted Kasai portoenterostomy (RAKPE) in patients with BA.
METHODS
Clinical data of 10 patients with BA who underwent RAKPE at the Seventh Medical Center of the People's Liberation Army General Hospital between December 2018 and December 2021 were retrospectively analyzed. One patient underwent Open Kasai portoenterostomy (OKPE) due to intraoperative bleeding. Consequently, nine patients were included in this study. Fifty-two patients who underwent OKPE during the same period served as the control group. Preoperative and postoperative biochemical indexes, surgery-related indexes, and postoperative clearance of jaundice (CJ) were recorded and statistically analyzed.
RESULTS
RAKPE was successfully completed in all nine patients, with an average total operative time of 352.2 minutes (including intraoperative cholangiography). Milk feeding resumed on an average 9.89 days postoperatively, and the average time of drainage tube removal was 18.11 days. All patients were followed up for 6 months to 2 years. The liver function indicators and bilirubin levels in 8 patients returned to normal within 3 months after surgery. Three patients developed recurrent cholangitis after discharge, with elevated white blood cell counts, liver function indicators, and bilirubin levels, requiring hospitalization for intravenous antibiotic treatment. The duration of cholangitis ranged from 5 to 8 months post-surgery. To date, no subsequent cases of cholangitis have occurred. All patients have normal liver function and bilirubin levels, with no intrahepatic bile duct dilatation on ultrasonography. Statistical analysis comparing these indicators with those of patients who underwent OKPE showed that the RAKPE group had longer operative times and postoperative drainage tube removal durations. However, there were no significant differences in intraoperative blood loss, postoperative oral milk intake resumption, postoperative hospital stay, or CJ at 3 months post-surgery.
CONCLUSION
RAKPE is technically feasible, safe, and effective for treating BA. Once the technique is mastered, RAKPE may achieve CJ outcomes comparable to those of OKPE.
Core Tip: We presented the results of some patients with biliary atresia treated with Robotic-assisted Kasai portoenterostomy and discussed the technical details. The conclusion is satisfactory, and the surgical outcome is largely consistent with that of Open Kasai portoenterostomy. Robot-assisted Kasai portoenterostomy can overcome the obstacles of traditional laparoscopic surgery and is likely to be more widely applied in the future.
