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Minimally invasive surgery for choledochal cysts: Laparoscopic versus robotic approaches

Annals of Hepato-Biliary-Pancreatic Surgery 2021년 25권 1호 p.71 ~ 77
윤종휘, 황호경, 이우정, 강창무,
소속 상세정보
윤종휘 ( Yoon Jong-Hwi ) - Yonsei University College of Medicine Department of Surgery
황호경 ( Hwang Ho-Kyoung ) - Yonsei University College of Medicine Department of Surgery
이우정 ( Lee Woo-Jung ) - Yonsei University College of Medicine Department of Surgery
강창무 ( Kang Chang-Moo ) - Yonsei University College of Medicine Department of Surgery

Abstract


Backgrounds/Aims: Minimally invasive surgery is a widely accepted approach in hepatobiliary surgery and choledochal cyst excision has also been performed by minimally invasive methods, including laparoscopic and robotic approaches. However, only a few studies have compared laparoscopic and robotic surgery. Therefore, we performed a comparative study between two groups, including cost aspects.

Methods: We retrospectively analyzed minimally invasive choledochal cyst excision at Severance Hospital in Seoul, South Korea from January 2005 to December 2018. A total of 39 patients that underwent minimally invasive choledochal cyst excision were identified. The 23 patients (58.9%) and 16 patients (41.1%) were enrolled in laparoscopic and robotic approach, respectively. We compared the patient’s characteristics, and perioperative outcomes between laparoscopic and robotic surgery groups.

Results: A comparative analysis between the two groups showed no differences in preoperative clinical characteristics. There were no significant differences in operative time, estimated blood loss, and postoperative complications, including biliary complication. The preoperative ASA score (p=0.021) and hospital stays (p=0.011) were the only clinical variables that differed between the two groups. All of the variables included in the cost analysis showed statistically significant differences (total hospital charge: p=0.035, patient’s bill: p≤0.001, operation: p=0.002, anesthesia: p=0.001, postoperative management: p=0.001).

Conclusions: The overall clinical outcomes between the laparoscopic and robotic approach to choledochal cyst were comparable. The surgical approach should be balanced based on the surgeons’ skill, patients’ general condition, disease extent, and economic status.

키워드

Choledochal cyst; Laparoscopy; Robotic surgical procedure

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