Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Surg Endosc. 2023 Jan;37(1):274-281. doi: 10.1007/s00464-022-09496-0. Epub 2022 Aug 4.
Robotic-assisted surgery (RAS) is being increasingly used in pediatric choledochal cysts (CCs), but is most commonly performed in older children and adolescents. The outcomes in young infants remain to be explored. The purpose of this study is to compare outcomes in infants aged ≤ 1 year with an older cohort.
From July 2015 to January 2020, a retrospective study was conducted to evaluate the RAS in patients with CCs at our institution. Patients were divided into two groups (group A ≤ 1 year old and group B > 1 year old). Demographics, intraoperative details, complications, and outcomes were analyzed.
A total of 79 patients were included in the study (28 patients in group A and 51patients in group B). The median age of patients at the surgery in group A was 4.9 months (IQR: 3.1-9.1), compared with 46.8 months (IQR: 28.5-86.5) in group B. Three patients in group A were neonates. No conversion to open surgery was required. No significant differences were found between the two groups including sex, Todani type, or diameter of the cysts. The diameter of the common hepatic duct was smaller in group A (6.0 ± 1.7 vs. 9.0 ± 3.0 mm; p < 0.001). Group A had the longer hepaticojejunostomy time [51(44-58) vs. 42(38-53) min; p = 0.013], while Group B had the longer cyst excision time [43(41-59) vs. 50(43-60) min; p = 0.005]. However, their total operative time and console time were similar. There were no statistical differences in length of hospital stay and complications between the two groups.
Robot-assisted cyst resection and hepaticojejunostomy are feasible and safe in infants ≤ 1 year old. Age cannot be considered an absolute contraindication for robotic surgery in patients with CCs.
机器人辅助手术（RAS）越来越多地用于小儿胆总管囊肿（CC），但最常用于年龄较大的儿童和青少年。婴儿的结果仍有待探索。本研究的目的是比较≤1 岁婴儿组和较年长组的结果。
2015 年 7 月至 2020 年 1 月，对我院 CC 患者的 RAS 进行回顾性研究。患者分为两组（A 组≤1 岁，B 组>1 岁）。分析人口统计学、术中细节、并发症和结果。
本研究共纳入 79 例患者（A 组 28 例，B 组 51 例）。A 组患者手术时的中位年龄为 4.9 个月（IQR：3.1-9.1），B 组为 46.8 个月（IQR：28.5-86.5）。A 组中有 3 例新生儿。无中转开腹手术。两组间性别、Todani 分型或囊肿直径无显著差异。A 组胆总管直径较小（6.0±1.7 vs. 9.0±3.0mm；p<0.001）。A 组肝肠吻合时间较长[51（44-58）比 42（38-53）min；p=0.013]，B 组囊肿切除时间较长[43（41-59）比 50（43-60）min；p=0.005]。然而，两组的总手术时间和控制台时间相似。两组的住院时间和并发症无统计学差异。
机器人辅助囊肿切除和肝肠吻合术在≤1 岁婴儿中是可行和安全的。年龄不能被认为是 CC 患者机器人手术的绝对禁忌症。
