Robot-assisted choledochal cyst resection in a child

Abstract

The generally accepted method for choledochal cysts is total resection of cystic extrahepatic bile ducts and gallbladder followed by biliodigestive anastomosis. Minimally invasive interventions have recently become the «gold» standard in pediatric hepatobiliary surgery. However, laparoscopic resection of choledochal cysts has certain disadvantages related to difficult positioning of instruments in narrow surgical field. The disadvantages of laparoscopy can be compensated by surgical robots. A 13-year-old girl underwent robot-assisted resection of hepaticocholedochal cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. Total anesthesia time was 6 hours. Laparoscopic stage took 55 min, docking of robotic complex - 35 min. Robotic stage of surgery required 230 min, removal of cyst and suturing the wounds - 35 min. Postoperative period was uneventful. Enteral nutrition was started after 3 days, and drainage tube was removed after 5 day. The patient was discharged after 10 postoperative days. The follow-up period was 6 months. Thus, robot-assisted resection of choledochal cysts in children is possible and safe.