Ann Surg Treat Res.  2018 Apr;94(4):190-195. 10.4174/astr.2018.94.4.190.

Comparison of surgical outcomes of intracorporeal hepaticojejunostomy in the excision of choledochal cysts using laparoscopic versus robot techniques

• Lee H
• Kwon W
• Han Y
• Kim JR
• Kim SW
• Jang JY

• KMID: 2407748
• DOI: http://doi.org/10.4174/astr.2018.94.4.190

Abstract

PURPOSE
Increasing surgical expertise in minimally invasive surgery has allowed laparoscopic surgery to be performed in many abdominal surgeries. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy are challenging and sophisticated surgeries because of the difficult anastomosis. Recent advances in robotic surgery have enabled more delicate and precise movements, and Endowrist instruments allow for securing sutures during anastomosis. This study aimed to compare surgical outcomes of laparoscopic and robotic hepaticojejunostomy in choledochal cyst excision.
METHODS
Sixty-seven patients who underwent laparoscopic or robotic-hybrid choledochal cyst excision from 2004 to 2016 were retrospectively analyzed and compared. In robotic surgery, dissection was performed laparoscopically, and hepaticojejunostomy was performed using a robotic platform.
RESULTS
The mean operative time was significantly longer in robotic surgery than in laparoscopic surgery (247.94 ± 54.14 minutes vs. 181.31 ± 43.06 minutes, P < 0.05). The mean estimated blood loss (108.71 ± 15.53 mL vs. 172.78 ± 117.46 mL, respectively, P = 0.097) and postoperative hospital stay (7.33 ± 2.96 days vs. 6.22 ± 1.06 days, P = 0.128) were comparable between procedures. Compared to the laparoscopic approaches, robotic surgery had significantly less short-term complications (22.4% vs. 0%, P = 0.029). There were more biliary leakage (n = 7, 14.3%) observed during the first 30 days after surgery in laparoscopy while none were observed in the robotic method.
CONCLUSION
Robotic surgery allow for more precise and secure sutures during anastomosis thereby reducing biliary complications. With expanding knowledge and expertise, robotic surgery may offer more advantages over laparoscopy in the era of minimally invasive surgery.

Keyword

Choledochal cyst; Minimally invasive surgical procedures; Robotic surgical procedures; Roux-en-Y anastomosis

MeSH Terms

Anastomosis, Roux-en-Y
Choledochal Cyst*
Humans
Laparoscopy
Length of Stay
Methods
Minimally Invasive Surgical Procedures
Operative Time
Retrospective Studies
Robotic Surgical Procedures
Sutures

Figure

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  Fig. 1 Port placement in robotic choledochal cyst excision.

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  Fig. 2 Operative time in robotic choledochal cyst excision.

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