Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2018; 6(7): 143-149
Published online Jul 16, 2018. doi: 10.12998/wjcc.v6.i7.143
Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review
Xian-Qiang Wang, Shu-Juan Xu, Zheng Wang, Yuan-Hong Xiao, Jing Xu, Zhen-Dong Wang, Di-Xiang Chen
Xian-Qiang Wang, Zheng Wang, Yuan-Hong Xiao, Zhen-Dong Wang, Di-Xiang Chen, Department of Pediatrics, PLA General Hospital, Beijing 100853, China
Shu-Juan Xu, Jing Xu, Center of Anesthesia and Operation, PLA General Hospital, Beijing 100853, China
Author contributions: Wang XQ and Xu SJ contributed equally to this work, and should be considered as co-first author; Wang Z and Chen DX designed the research; Xiao YH, Wang ZD, Xu J, Wang XQ and Chen DX performed the research; Wang XQ and Xu SJ analyzed the data; Wang XQ, Xu J and Chen DX wrote the manuscript.
Supported by the PLA general hospital Clinical Support Grant, No. 2017FC-TSYS-3010.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: 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/
Correspondence to: Di-Xiang Chen, MD, PhD, Doctor, Surgeon, Department of Pediatric, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. 301xewk@sina.com
Telephone: +86-10-66938418 Fax: +86-10-66938418
Received: February 28, 2018
Peer-review started: February 28, 2018
First decision: March 15, 2018
Revised: March 23, 2018
Accepted: April 22, 2018
Article in press: April 22, 2018
Published online: July 16, 2018
Processing time: 138 Days and 19.6 Hours
Abstract

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3 (0.3-15.9) years; the male-to-female ratio was 1:3.5 (19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9% (79/86). The average total operation time was 426 (180-520) min, the operation time on the machine was 302 (120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of robotic-assisted choledochocystectomy was 8.8 d. Eight patients had biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons’ experience, robotic surgery may become a new trend in this surgical procedure.

Keywords: Choledochocystectomy; Robotic surgery; Pediatrics; Congenital choledochal cysts

Core tip: Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was carried out for a girl at our hospital, then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery.