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Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches
Ann Hepatobiliary Pancreat Surg 2018 Nov;22(4):359-66
Published online November 30, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Jang Hun Han, Jae Hoon Lee, Dae Wook Hwang, Ki Byung Song, Sang Hyun Shin, Jae Woo Kwon, Young Joo Lee, Song Cheol Kim, Kwang Min Park

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Received October 25, 2018; Revised October 27, 2018; Accepted October 30, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
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.
Keywords : Choledochal cyst; Robotic surgery; Laparoscopic surgery

 

November 2018, 22 (4)