Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children.
OBJECTIVE
Choledochal cysts have traditionally been treated as an open procedure. However, recent publications from some large volume centres show that minimally invasive surgery has become their standard approach. Robotic surgical systems facilitate a surgeon's ability to undertake complex procedures. We present our experience of using robot assistance to treat choledochal cysts.


METHODS
Children admitted with a choledochal cyst from March 2009 to Nov 2012 were included. There were 27 patients (20 females). Mean age 5.4 years (range 0.3-15.9). Mean weight 21.9 kg (range 5.9-78.8); 10 weighed <10 kg. The choledochal cysts were types 1c(12), 1f(10) and 4(5). The da vinci Surgical System was used for the robot-assisted resection of the choledochal cyst and hepaticojejunostomy. Roux loop was fashioned extra-corporeally. Mean follow-up is 2.7 years (range 0.9-4.7).


RESULTS
22 cases were completed successfully with robotic assistance. Five open conversions were for anatomical concerns or technical reasons. One child had three complications (omental hernia, anastomotic stricture and subsequent bile leak). Patients were on full feeds by a median of 5 days (range 3-6) and discharged after 6 days (range 4-7).


CONCLUSIONS
Robotic-assisted resection of choledochal cysts in children is safe. They made a rapid recovery with a good cosmetic outcome.
Children's Liver Unit*, Department of Paediatric Surgery, Leeds Children's Hospital, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK, naved.alizai@leedsth.nhs.uk.
Naved K
NK
Alizai
Michael J
MJ
Dawrant
Azad S
AS
Najmaldin
D000293:Adolescent; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007422:Intestines / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome