Vol.:(0123456789) 1 3 Pediatric Surgery International https://doi.org/10.1007/s00383-019-04518-w ORIGINAL ARTICLE Robotic‑assisted surgery for choledochal cyst in children: early experience at Vietnam National Children’s Hospital Hien Duy Pham 1  · Yuichi Okata 1,2  · Hoan Manh Vu 1  · Nam Xuan Tran 1  · Quang Thanh Nguyen 1  · Liem Thanh Nguyen 1 Accepted: 25 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose We aimed to describe our robotic-assisted surgery (RAS) techniques and assess the early results of RAS for chole- dochal cysts in children. Methods We conducted a retrospective chart review of children who underwent RAS for a congenital choledochal cyst at our institution between February 2013 and August 2016. We analyzed patient characteristics, operative data, and postopera- tive outcomes. Results Thirty-nine patients underwent RAS for a choledochal cyst (female 30). The operation was performed with four robotic ports and one laparoscopic port for the assistant. The Roux loop was fashioned extracorporeally. Twenty patients (51.3%) had a Todani Type I cyst and the others had Type IV. The mean patient age and weight and choledochal cyst diam- eter at the time of the operation were 40.2 months (range 5–108 months), 13.4 kg (range 6.5–29 kg), and 27.2 mm (range 9–112 mm), respectively. The mean operating time was 192.7 min (range 150–330 min). There were no intraoperative complications; no conversions to laparoscopic or open surgery; and no postoperative complications, including cholangitis, cholelithiasis, or anastomotic stenosis. Conclusion Pediatric RAS CC resection is safe and feasible. The robot-assisted technique overcame technical difculties. However, in pediatric cases, a skilled robotic surgical team and procedural modifcations are needed. Keywords Robotic-assisted surgery · Choledochal cyst · Children · Minimally invasive surgery Introduction Choledochal cysts (CCs) are rare entities characterized by congenital biliary tract dilatation, and the incidence of CCs is higher in Asian countries. Although the pathological mechanism of CCs is still unclear, complete cyst excision with Roux-en-Y hepaticojejunostomy is the treatment of choice [1]. Rapid advancements in minimally invasive surgery, including laparoscopic and robotic surgery, have changed the approach to general abdominal surgery, particularly for hepatobiliary diseases. In 1995, Farello et al. performed the frst laparoscopic CC resection with Roux-en-Y hepaticoen- terostomy in a 6-year-old girl [2]. Over the last decade, with the advent of laparoscopy, several authors have reported the feasibility and benefts of laparoscopic CC excision [3–6]. However, it has not been widely used, because laparoscopic cyst resection and, especially, laparoscopic hepaticojejunos- tomy are quite technically demanding. Laparoscopic choledochal cyst excision with hepaticoje- junostomy has been the standard treatment for CCs at our institution since 2007, and we previously reported our expe- rience [7, 8]. Although the laparoscopic approach to CCs in children is feasible and efective, there are technical difcul- ties, especially with the hepaticojejunostomy. Recently, some surgeons have reported their experience with robotic-assisted surgery (RAS) for CCs in adult patients [9, 10], and it has been utilized to facilitate complex mini- mal access procedures in multiple surgical disciplines. RAS ofers several advantages, including three-dimensional visu- alization through a stereo-endoscope controlled by the pri- mary surgeon, intuitive instrument control, tremor reduction, * Hien Duy Pham duyhien1972@yahoo.com 1 Department of Pediatric Surgery, Vietnam National Children’s Hospital, 18/879 La Thanh, Dong Da, Hanoi, Vietnam 2 Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan