Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg.
OBJECTIVE
Laparoscopic resection of choledochal cysts and hepaticojejunostomy have been described in children since 1995, but these can be technically demanding procedures. Robotic surgical systems can facilitate complex minimal-access procedures. In 2009, we made the transition from conventional laparoscopic to robotic-assisted choledochal cyst excision with hepaticojejunostomy. We present our experience in children weighing less than 10 kg.


METHODS
During 2009, 5 children weighing less than 10 kg underwent robotic resections of choledochal cysts and hepaticojejunostomy using the da Vinci surgical system. The Roux loop was fashioned extracorporeally. Mean age was 1 year (range, 0.5-1.4), and mean weight was 8.5 kg (range, 7.6-9.5). All 5 had type 1c cysts, and 3 were very large.


RESULTS
All 5 cases were treated successfully by robotic resection of the cyst and hepaticojejunostomy. Feeding was established by a median of 4 days (range, 3-6), and patients were discharged after a median of 6 days (range, 5-7) with no postoperative complications.


CONCLUSIONS
The technique is safe and effective in children weighing less than 10 kg. The authors found ergonomic advantages in using robotic-assisted surgery for this complex minimal-access procedure.
Children's Liver and GI Unit, Leeds General Infirmary, LS1 3EX Leeds, United Kingdom. kmdawrant@talk21.com
Michael J
MJ
Dawrant
Azad S
AS
Najmaldin
Naved K
NK
Alizai
D000700:Analgesics / Q000627:therapeutic use; D001835:Body Weight; D015529:Choledochal Cyst / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay; D008099:Liver / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy; D012371:Robotics
D000700:Analgesics