Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):71-77. 10.14701/ahbps.2021.25.1.71.

Minimally invasive surgery for choledochal cysts: Laparoscopic versus robotic approaches

Affiliations
  • 1Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 2Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea

Abstract

Backgrounds/Aims
Minimally invasive surgery is a widely accepted approach in hepatobiliary surgery and choledochal cyst excision has also been performed by minimally invasive methods, including laparoscopic and robotic approaches. However, only a few studies have compared laparoscopic and robotic surgery. Therefore, we performed a comparative study between two groups, including cost aspects.
Methods
We retrospectively analyzed minimally invasive choledochal cyst excision at Severance Hospital in Seoul, South Korea from January 2005 to December 2018. A total of 39 patients that underwent minimally invasive choledochal cyst excision were identified. The 23 patients (58.9%) and 16 patients (41.1%) were enrolled in laparoscopic and robotic approach, respectively. We compared the patient’s characteristics, and perioperative outcomes between laparoscopic and robotic surgery groups.
Results
A comparative analysis between the two groups showed no differences in preoperative clinical characteristics. There were no significant differences in operative time, estimated blood loss, and postoperative complications, including biliary complication. The preoperative ASA score (p=0.021) and hospital stays (p=0.011) were the only clinical variables that differed between the two groups. All of the variables included in the cost analysis showed statistically significant differences (total hospital charge: p=0.035, patient’s bill: p≤0.001, operation: p=0.002, anesthesia: p=0.001, postoperative management: p=0.001).
Conclusions
The overall clinical outcomes between the laparoscopic and robotic approach to choledochal cyst were comparable. The surgical approach should be balanced based on the surgeons’ skill, patients’ general condition, disease extent, and economic status.

Keyword

Choledochal cyst; Laparoscopy; Robotic surgical procedure

Figure

  • Fig. 1 Minimally invasive approach to treat choledochal cyst. Laparoscopic isolation (A), and resection of choledochal cyst (B). Note subsequent laparoscopic choledochojejunostomy (C) and robotic reconstruction (D). B, bile duct; CC, choledochal cyst; D, duodenum; J, jejunum.

  • Fig. 2 Time-dependent biliary stricture-free probability.


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