Zhang Meng-Xin, Tang Jing-Feng, Zheng Ze-Bing, Zhang Yong-Kang, Cao Guo-Qing, Li Shuai, Zhang Xi, Zhou Ying, Li Kang, Zhou Yun, Wang Chen, Chi Shui-Qing, Zhang Jin-Xiang, Tang Shao-Tao
Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Surg Endosc. 2025 Feb;39(2):1128-1139. doi: 10.1007/s00464-024-11452-z. Epub 2024 Dec 19.
Many variables, including age at surgery, disease type, surgical approaches and perioperative management factors have been demonstrated to influence efficacy in BA infants, however, the effect of surgical performance remains unclear. The objective of this retrospective study was to compare the postoperative efficacy and surgical performance of robotic (RKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for BA.
Between October 2018 and June 2023, 158 type III BA patients undergoing minimally invasive surgery (RKPE = 66, LKPE = 92) were included in this multicenter retrospective study. All procedures were performed by surgical teams experienced in Kasai portoenterostomy techniques. Technical performance was quantified and analyzed using the Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments (GERT). Postoperative outcomes and surgical performance were compared.
Compared with LKPE group, RKPE group had shorter fibrous cone transection time (48.92 ± 6.98 vs. 61.45 ± 8.98 min; p < 0.001), shorter hepaticojejunostomy time (47.55 ± 6.57 vs. 59.93 ± 7.88 min; p < 0.001) and less estimated intraoperative bleeding [7.00 (5.00-10.00) vs. 13.50 (10.50-16.50) mL; p < 0.001]. More importantly, RKPE group showed a superior OSATS score [30.50 (29.00-31.00) vs. 28.00 (28.00-29.00); p < 0.001], number of errors (46.62 ± 6.32 vs. 56.40 ± 6.82 times/case; p < 0.001), and number of events [9.40 (8.40-10.40) vs. 16.00 (14.00-17.80) times/case; p < 0.001]. On postoperative days 1 and 3, RKPE group had lower C-reactive protein levels (19.87 ± 12.28 vs. 27.05 ± 11.16 mg/L, p < 0.001; 14.88 ± 7.11 vs. 20.73 ± 9.09 mg/L, p < 0.001). During follow-up, RKPE group had higher jaundice clearance rate at 3 (68.18% vs. 51.09%; p = 0.032) and 6 months (78.79% vs. 64.13%; p = 0.047) postoperatively. However, the cholangitis rate within 1 year postoperatively (46.97% vs. 50.00%; p = 0.707), as well as one-year (75.76% vs. 72.83%; p = 0.678) and two-year survival with native liver rates (68.42% vs. 66.67%; p = 0.857), were comparable between two groups.
RKPE provided superior technical skill performance and a higher jaundice clearance rate than LKPE, indicating that it may be a better minimally invasive option for BA. In addition, the survival with native liver rate showed no significant difference between the two cohorts, which needs to be confirmed by further study.
许多变量，包括手术年龄、疾病类型、手术方式和围手术期管理因素，已被证明会影响胆管闭锁（BA）患儿的治疗效果，然而，手术操作的影响仍不清楚。这项回顾性研究的目的是比较机器人Kasai肝门空肠吻合术（RKPE）与腹腔镜Kasai肝门空肠吻合术（LKPE）治疗BA的术后疗效和手术操作情况。
在2018年10月至2023年6月期间，158例接受微创手术的III型BA患者（RKPE组66例，LKPE组92例）被纳入这项多中心回顾性研究。所有手术均由精通Kasai肝门空肠吻合术技术的手术团队进行。使用客观结构化技术技能评估（OSATS）和通用错误评分工具（GERT）对技术操作进行量化和分析。比较术后结果和手术操作情况。
与LKPE组相比，RKPE组的纤维锥横断时间更短（48.92±6.98 vs. 61.45±8.98分钟；p<0.001），肝空肠吻合时间更短（47.55±6.57 vs. 59.93±7.88分钟；p<0.001），估计术中出血量更少[7.00（5.00 - 10.00）vs. 13.50（10.50 - 16.50）mL；p<0.001]。更重要的是，RKPE组的OSATS评分更高[30.50（29.00 - 31.00）vs. 28.00（28.00 - 29.00）；p<0.001]，错误数量更少（46.62±6.32 vs. 56.40±6.82次/病例；p<0.001），事件数量更少[9.40（8.40 - 10.40）vs. 16.00（14.00 - 17.80）次/病例；p<0.001]。术后第1天和第3天，RKPE组的C反应蛋白水平更低（19.87±12.28 vs. 27.05±11.16 mg/L，p<0.001；14.88±7.11 vs. 20.73±9.09 mg/L，p<0.001）。在随访期间，RKPE组术后3个月（68.18% vs. 51.09%；p = 0.032）和6个月（78.79% vs. 64.13%；p = 0.047）的黄疸清除率更高。然而，两组术后1年内的胆管炎发生率（46.97% vs. 50.00%；p = 0.707）以及1年（75.76% vs. 72.83%；p = 0.678）和2年的自体肝生存率（68.42% vs. 66.67%；p = 0.857）相当。
与LKPE相比，RKPE具有更优的技术操作表现和更高的黄疸清除率，表明它可能是BA更好的微创选择。此外，两组的自体肝生存率无显著差异，这需要进一步研究证实。
