Robot-assisted choledochal cysts resection in children across all ages: a larger cohort single-center experience with 318 Cases

Robotic-assisted surgery (RAS) is an emerging alternative to laparoscopic surgery (LAS) for the treatment of choledochal cysts. We aim to evaluate the safety and efficacy of robotic-assisted choledochal cyst resection (RACC) in children from neonates to 16-year-olds. In this retrospective study, 318 patients undergoing RAS between April 2020 and July 2025 were compared with 489 patients undergoing LAS between January 2015 and July 2025. The robotic cohort was stratified into six age-based subgroups: R1 (neonates), R2 (> 1 to ≤ 3 months), R3 (> 3 to ≤ 12 months), R4 (> 12 to ≤ 36 months), R5 (> 36 to ≤ 120 months), and R6 (> 120 to ≤ 192 months). The overall postoperative complication rate was significantly lower in the RAS group compared to the LAS group (p = 0.020), with significantly reduced rates of bile leakage and anastomotic stenosis (p = 0.032). The reoperation rate was also significantly lower in the RAS group (p = 0.042). Within the RAS group, the robotic installation time was significantly longer in the R1 group (p = 0.0328). Among patients older than 3 months, the total operative time was significantly longer in the R6 group (p = 0.0438), while the R3 group had a significantly shorter total operative time compared to other groups (p = 0.0018). Additionally, the robotic console time was significantly longer in the R6 group compared to other groups (p = 0.0248). RACC is safe and effective for children across all ages, demonstrating lower complication and reoperation rates compared to laparoscopic surgery. Robotic surgery involving neonates or older children with large cysts should be performed at experienced pediatric centers.