Robot-assisted resection of a common bile duct cyst with hepaticoduodenostomy in a child: a case report

A choledochal cyst is a rare congenital anomaly of the bile ducts. In recent years, surgical approaches to its treatment have evolved from laparotomy to laparoscopy and robot-assisted surgery. This article analyzes the clinical course of a 4-year-old girl diagnosed with a choledochal cyst. The patient’s main complaints were recurrent upper abdominal pain accompanied by a single episode of jaundice at age 3 years. At the time of admission, the patient’s symptom duration was 1.5 years. Preoperative evaluation included liver function tests, coagulation profile, ultrasound, and magnetic resonance cholangiopancreatography, which revealed a type I choledochal cyst measuring 27.3 mm in diameter. Robot-assisted choledochal cyst resection followed these principles: cyst dissection with clipping of the distal common hepatic duct, proximal cyst dissection with transverse transection at the level of the non-dilated common hepatic duct, and hepaticoduodenostomy creation. Operative time was 240 minutes: docking time, 20 minutes; console time, 220 minutes. Enteral nutrition was initiated on postoperative day 3, and full enteral nutrition was achieved on postoperative day 5. The child demonstrated successful postoperative recovery, with early transition to a full enteral diet and discharge for outpatient follow-up on postoperative day 7. At follow-up, the child had normal weight and height parameters, no pain, and normal bile duct diameter on liver ultrasound. Compared with laparoscopy, robot-assisted surgery for congenital choledochal cysts in children offers advantages including enhanced visualization and exceptional robotic instrument maneuverability, resulting in less tissue damage, greater precision in hepaticoduodenostomy creation, and faster patient recovery. This case demonstrates the potential of robot-assisted surgery for treating children with hepatobiliary pathology.