Robotic-Assisted Excision of Choledochal Cyst and Hepaticojejunostomy in Children

Choledochal cyst represents a significant congenital malformation of the biliary tract in children, often requiring surgical management to prevent severe complications such as cholestasis, recurrent pancreatitis, malignancy and liver failure. An increasing number of high-volume centres have adopted minimally invasive techniques, especially robotic-assisted approaches, due to their enhanced precision, visualization and postoperative outcomes. The aim of this chapter is to describe in detail the robotic-assisted excision of choledochal cyst and hepaticojejunostomy, emphasizing preoperative preparation, trocar placement and the main surgical steps to ensure optimal surgical outcome. The patient is positioned supine, with a slight reverse Trendelenburg tilt. Surgical steps include aspiration and dissection of the cyst, resection of the hepatic duct, creation of the hepaticojejunostomy and placement of the drainage. Based on the results, robotic-assisted surgery improves outcomes in choledochal cyst management, making complex procedures safer and more precise. The patients showed a rapid recovery, with the drainage removed on day 4 and discharge occurring between days 4 and 6, depending on the patient’s clinical condition. The hepaticojejunostomy was stable and functional in all cases, offering excellent postoperative outcomes in paediatric patients. Robotic - assisted technology represents an advance for minimal invasive management of choledochal cyst in paediatric patients. The technique is safe, effective and advantageous. The conversion and complication rates are comparable favourably to conventional approaches. The authors prefer the use of three arms of the da Vinci system, a fixed liver retractor and an extracorporeal Roux-en-Y loop formation. The aim of this chapter is to describe step by step the technique of robotic assisted excision of choledochal cyst and hepaticojejunostomy in children. The importance of meticulous technique and attention to details throughout the entire management period are emphasized strongly.