Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg

Abstract Background/Purpose Laparoscopic resection of choledochal cysts and hepaticojejunostomy have been described in children since 1995, but these can be technically demanding procedures. Robotic surgical systems can facilitate complex minimal-access procedures. In 2009, we made the transition fr...

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Bibliographic Details
Published in:Journal of pediatric surgery 2010-12, Vol.45 (12), p.2364-2368
Main Authors: Dawrant, Michael J, Najmaldin, Azad S, Alizai, Naved K
Format: Article
Language:English
Subjects:
Analgesics - therapeutic use
Body Weight
Choledochal cyst
Choledochal Cyst - surgery
Female
Humans
Infant
Infants
Jejunostomy - methods
Jejunostomy - statistics & numerical data
Laparoscopy - methods
Laparoscopy - statistics & numerical data
Length of Stay
Liver - surgery
Pain, Postoperative - drug therapy
Pediatrics
Robotic surgery
Robotics
Surgery
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Summary:Abstract Background/Purpose Laparoscopic resection of choledochal cysts and hepaticojejunostomy have been described in children since 1995, but these can be technically demanding procedures. Robotic surgical systems can facilitate complex minimal-access procedures. In 2009, we made the transition from conventional laparoscopic to robotic-assisted choledochal cyst excision with hepaticojejunostomy. We present our experience in children weighing less than 10 kg. Methods During 2009, 5 children weighing less than 10 kg underwent robotic resections of choledochal cysts and hepaticojejunostomy using the da Vinci surgical system. The Roux loop was fashioned extracorporeally. Mean age was 1 year (range, 0.5-1.4), and mean weight was 8.5 kg (range, 7.6-9.5). All 5 had type 1c cysts, and 3 were very large. Results All 5 cases were treated successfully by robotic resection of the cyst and hepaticojejunostomy. Feeding was established by a median of 4 days (range, 3-6), and patients were discharged after a median of 6 days (range, 5-7) with no postoperative complications. Conclusion The technique is safe and effective in children weighing less than 10 kg. The authors found ergonomic advantages in using robotic-assisted surgery for this complex minimal-access procedure.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2010.08.031