John Meehan, MD
Introduction: Robotic surgery may enable surgeons to perform complex minimally invasive procedures that they may have otherwise elected to perform via an open approach. The articulating instruments eliminate the fulcrum effect and filter tremor. Additionally, the 12x 3-D imaging allows for high magnification and depth perception. This video is a demonstration of a choledochal cyst resection using the Da Vinci surgical robot, implementing a completely intracorporeal approach in a 2 year old, 15 kg child.
Methods: The Da Vinci standard 3 arm surgical robot was used with two 5 mm instrument ports and one 12 mm camera port. Two additional ports, one for liver retraction and one multi-use accessory port, were also required.
Results: The procedure was accomplished in 5.5 hrs. No complications occured. The patient went home post-operative day 3. She has done well and is now 2 years out from surgery with no problems.
Conclusion: Robotic surgery is safe and effective for resecting a choledochal cyst, even in small children. The entire procedure can be performed intracorporeally. Due to the rarity of this anomaly, pediatric surgery centers will need to combine their experiences in order to determine relevant outcomes information.