Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches

BACKGROUNDS/AIMS: In adult choledochal cysts, complete excision of cyst with Roux-en-Y hepaticojejunostomy by laparoscopy is typically been performed, but there is now a trend towards adopting robot-assisted resection. METHODS: From January 2014 to December 2017, 22 patients who underwent robotic procedure were classified as Group 1, and 34 patients who underwent the same laparoscopic procedure as Group 2. In addition, from September 2009 to July 2011, 13 patients who underwent laparoscopic procedure were classified as Group 3. The perioperative outcomes and short-term postoperative morbidity levels were evaluated in three groups. RESULTS: In all groups, there were more women than men, and the mean age and BMI did not differ significantly. Since 2014, jejunojejunostomy was performed extracorporeally and the mean operation time was shorter in Group 1 (258.5±52.9 min) and Group 2 (236.2±62.9 min) than Group 3 (395.2±85.9 min). [p=0.00 (1 vs 3), 0.00 (2 vs 3)] The median hospital stay was 7 days in Group 1 and 2, and shorter than 9 days in Group 3. [p=0.00 (1 vs 3), 0.011 (2 vs 3)] In Group 1, there were three postoperative complications, which included cholangitis, bile leakage and umbilical herniation, respectively). In Group 2, there were seven of postoperative complications, which included choledochojejunostomy site stricture & intrahepatic duct stone, choledochojejunostomy site stone, jejunal branch bleeding, portal vein thrombus, acute pancreatitis, adhesive ileus, and A-loop syndrome. In Group 3, there were three of postoperative complications, which included 2 hepaticojejunostomy site stricture and 1 paralytic ileus. CONCLUSIONS: Robot-assisted resection of a choledochal cyst with Roux-en-y hepaticojejunostomy is a safe and feasible approach with short-term results that are comparable to those of laparoscopic surgery.