Robot-assisted radical resection for choledochal cysts in infants under three months of age: a multicenter retrospective study

Lirong Zhang, Peng Song, Yunfeng Xiao, Quankun Zhou, Jie Yang, Libing Zhang, Z L Yang

Background To analyze the clinical efficacy and surgical experience of robot-assisted radical resection for choledochal cysts in infants under three months of age. Methods This was a multicenter retrospective study conducted at the Department of Pediatric Surgery, Mianyang Central Hospital, and Chengdu Women's and Children's Central Hospital. A total of 31 patients diagnosed with congenital choledochal cysts under three months of age between May 2021 and May 2026 were included. The cohort comprised 9 boys and 22 girls, aged 10–86 days (median age: 52 days), with a body weight ranging from 3.0 to 6.5 kg (mean weight: 3.83 ± 0.75 kg). The primary clinical manifestation was obstructive jaundice. All patients underwent robot-assisted radical resection of choledochal cysts and were discharged after the resumption of feeding and the absence of postoperative complications. Results Surgery was successfully completed in all 31 cases without conversion to open surgery. The operative time ranged from 173 to 239 min, with a median time of 190 min. All patients initiated feeding 24–48 h postoperatively, and No major early complications (e.g., bile leakage, pancreatitis, intestinal obstruction) occurred. Transient hyperbilirubinemia was observed in 12 patients (38.7%), which resolved with conservative management. The postoperative hospital stay ranged from 8 to 11 days, with a median stay of 9 days. All patients were followed up for 6–28 months. During the follow-up period, symptoms related to biliary obstruction resolved, and there were no occurrences of internal hernia, intestinal obstruction, or biliary stricture. All patients exhibited normal growth and development. Conclusion For infants under three months of age with congenital choledochal cysts who present with surgical indications, robot-assisted radical resection appears safe and effective.This approach appears safe and feasible for carefully selected infants under three months of age. Favorable outcomes were observed, including successful completion of surgery without conversion, absence of major complications, and satisfactory cosmetic results. Further comparative studies are warranted to establish its role relative to laparoscopic surgery.