Comparative analysis of Da Vinci robotic surgery and laparoscopic surgery for congenital choledochal cyst in neonates

Abstract

Objective

This study aims to compare and analyze the clinical efficacy and safety of Da Vinci robotic surgery (RS) versus traditional laparoscopic surgery (LS) for the treatment of congenital choledochal cyst (CCC) in neonates.

Methods

We retrospectively analyzed sixty-seven neonatal cases of CCC admitted to our hospital between December 2018 and December 2024. The cases were categorized into the robotic group (n = 32) and the laparoscopic group (n = 35) based on the surgical technique employed. We systematically compared baseline data, intraoperative metrics, and postoperative recovery between the two groups, focusing on total operative time, biliary-intestinal anastomosis time, and postoperative recovery outcomes.

Results

The two groups were comparable regarding baseline characteristics such as age, gender, weight, and cyst diameter (P > 0.05), with no significant differences in preoperative general conditions (P > 0.05); The total operative time was longer for RS compared to LS (208.54 ± 10.43 min vs. 194.54 ± 17.21 min, P = 0.016). However, the time required for biliary-intestinal anastomosis was shorter in RS (38.25 ± 9.78 min vs. 52.40 ± 9.83 min, P < 0.001), and intraoperative bleeding was significantly lower (P < 0.05); Postoperative abdominal drainage was significantly reduced in RS, with a shorter duration for drainage tube removal, demonstrating a statistically significant difference (P < 0.05). There was no statistically significant difference in the overall complication rate between the two groups.

Conclusion

Da Vinci robotic-assisted surgery is safe and feasible for the treatment of neonatal CCC. RS offers advantages such as a shorter biliary-intestinal anastomosis time, reduced tissue trauma, and faster recovery, warranting its promotion in neonatal surgical practices.

Trial registration

Retrospectively registered.

Introduction

Congenital choledochal cysts (CCC), also known as congenital choledochal dilatation, are prevalent congenital disorders characterized by developmental malformations of the biliary system, resulting in cystic or spindle-shaped dilatation of the common bile ducts. The main clinical symptoms include abdominal pain, abdominal mass, and jaundice [1, 2]. CCC are more frequently observed in Asian populations, with an incidence of approximately 1:1,000, and they are known to be more common in women than in men [3, 4]. With advances in prenatal diagnostic techniques, the detection rate of CCC has increased, allowing for identification during pregnancy [5, 6]. However, the necessity for surgery in this group of children remains a topic of debate in clinical practice. In recent years, surgical treatment of CCC in the neonatal period has been demonstrated to be a safe and feasible option, although the choice of surgical procedure has not been standardized. The literature suggests that robotic surgery (RS) has certain advantages in complex hepatobiliary surgery and may be particularly suitable for CCC in low-birth-weight infants [7]. Nonetheless, due to the characteristics of neonates—such as limited abdominal space and more delicate tissues and organs—the applicability of robotic-assisted surgery in the treatment of neonatal CCC remains a significant concern [8]. There are limited reports in the literature, indicating that further studies are necessary to evaluate its safety and feasibility.

This study investigates the efficacy of RS and LS for congenital choledochal cysts in neonates by collecting and retrospectively comparing sixty-seven cases of neonatal CCC from December 2018 to December 2024. The aim is to assess the safety and efficacy of the two surgical modalities and provide a reference for the treatment of neonatal CCC.

Methods

Clinical data

This study retrospectively analyzed the clinical data of neonates who underwent radical resection of choledochal cysts (CCC) at the Affiliated Hospital of Zunyi Medical University between December 2018 and December 2024. Patients in the Da Vinci robotics group were collected from 2021 to 2024, and in the conventional laparoscopy group from 2018 to 2024. The inclusion criteria were as follows: ①CCC diagnosed by magnetic resonance cholangio-pancreatic imaging (MRCP); ②children aged ≤ 28 days who were operated on using the new-generation Da Vinci RS or conventional laparoscopic surgery (LS). The exclusion criteria included: ①cases where imaging examinations could not clarify the diagnosis of CCC; ②patients with severe congenital cardiopulmonary anomalies (ASA classification ≥ III); ③patients with other congenital anomalies requiring emergency management. A total of sixty-seven patients were included, all of whom underwent standard procedures: total cyst resection followed by Roux-en-Y anastomosis of the hepatic jejunum. The patients were divided into two groups based on the surgical approach: the robotic group (n = 32), which was operated on using the Da Vinci Xi system, and the conventional laparoscopic group (n = 35), which was operated on using standard laparoscopic instruments. All surgeries were performed by the same experienced surgical team to minimize variability in surgeon skill, and the diagnosis of CCC was confirmed preoperatively through ultrasound and MRCP (Fig. 1A), clarifying the morphology of the choledochal cysts. Whether the surgical approach using da Vinci system or laparoscopy was decided between the patient’s parents according to their wishes. The family was fully informed about the specifics of the two surgical methods before the operation, and they voluntarily chose their own surgical method according to their own conditions.

Fig. 1.

Robot-assisted surgery of choledochal cysts (A) MRCP indicates the location of choledochal cyst; (B) Ports arrangement; (C) Suspending the ligamentum teres hepatis and gallbladder fossa; (D) Extracorporeal jejunojejunostomy; (E) Dissecting and decompression the cyst; (F) Ldetaching the proximal end of the cyst and trimming the hepatic duct of the hilar part; (G) End-to-side hepaticojejunostomy; (H) Drainage tube placement

This study strictly adhered to the ethical guidelines of the Declaration of Helsinki and received approval from the Ethics Committee of our hospital (approval number: KLL-2025-032). All legal guardians of the children provided written informed consent. The sex, age, weight, serum bilirubin, and liver function were retrospectively collected from patients before surgery.

Surgical methods

Robotic surgery of choledochal cysts

1. Preoperative preparation:

Following the administration of general anesthesia and tracheal intubation, the patient was positioned supine, with the surgical table elevated by approximately 10 cm, particularly in neonates. After routine disinfection of the surgical field and draping, four trocar holes were created. An 8 mm trocar, labeled as ‘a’, was inserted through a median incision at the umbilicus to establish an artificial CO₂ pneumoperitoneum at a pressure of 6–8 mmHg, which was appropriately reduced for neonates. This trocar facilitated video recording and the establishment of pneumoperitoneum. Additionally, two 8 mm trocars, designated as ‘b’ and ‘c’, were symmetrically placed 8 cm above the umbilicus, positioned 8 cm on either side of the horizontal line, maintaining a distance of 12–15 cm to optimize space for robotic arm movement. A 5 mm trocar, labeled ‘d’, was placed 3–5 cm below the vertical line connecting the umbilicus and the midpoint of the left upper abdominal incision for intraoperative drainage and ancillary procedures (see Fig. 1B). Intraoperative fluorescence navigation was implemented through intravenous injection of indocyanine green (0.1 mg/kg) 15 min prior to surgery.

• 2.Choledochal cystectomy and Roux-en-Y hepaticojejunal anastomosis.

The robotic procedures were conducted in accordance with standardized technical protocols, utilizing the Da Vinci Surgical System Xi, as previously documented [9, 10]. To achieve complete visualization of the hepatic portal anatomy, the liver was elevated by suspending the round ligament and the gallbladder fossa (Fig. 1C). Following the identification of the Ligament of Treitz, extracorporealization was performed 20 cm from the proximal jejunum. Roux-Y collaterals were prepared by externally inserting a bowel tube through the umbilical incision (Fig. 1D), which was then retracted into the abdominal cavity in a tension-free manner.

After docking the robotic system, the surgeon at the main console precisely manipulates the robotic arm through the three-dimensional imaging system to complete the luminal biliary dissection, perform choledochal cyst excision, cholecystectomy, and anastomosis of the jejunal biliary branch of the hepatic duct. The intraoperative traction suture technique was employed to create a three-dimensional surgical space by placing traction sutures at the distal end of the gallbladder and the round ligament of the hepatic margin, respectively. For cysts larger than 5 cm in diameter, an ultrasonic knife was utilized to puncture and decompress the cyst (Fig. 1E), while a robotic electrocoagulation hook was employed to perform “membrane dissection” along the anterior and posterior walls of the cyst, ensuring complete resection of the distal end up to the stricture (Fig. 1F). Subsequently, the diameter of the residual common hepatic duct was accurately measured to ensure that the anastomosis was at least 1 cm; a continuous full-thickness bile-intestinal end-to-end anastomosis was performed using a 5 − 0 absorbable suture (Fig. 1G), and intraoperative real-time fluorescence imaging was conducted to confirm biliary patency. Anastomotic closure was assessed by flushing with 37 °C heparinized saline, while intestinal blood flow and bile leakage were monitored. After completing the bile-intestinal anastomosis, the robotic arm was withdrawn, and an abdominal drainage tube was placed under the anastomosis through trocar ‘d’. The resected choledochal cyst and gallbladder were then removed through the umbilicus and auxiliary trocar, followed by closure of the abdomen (Fig. 1H).

Laparoscopic surgery of choledochal cysts

1. laparoscopic choledochal cystectomy and Roux-en-Y hepaticojejunostomy.

Laparoscopic surgery was conducted as previously described [11, 12]. The round hepatic ligament was suspended (Fig. 2A), and the cyst was punctured percutaneously. Bile was aspirated, followed by the injection of contrast medium, and cholangiography was performed to delineate the extent and type of the lesion. Additionally, the size, texture, and color of the liver were examined, along with the assessment for ectopic blood vessels in the porta hepatis. The cyst was thoroughly dissected from the surrounding tissues, isolating its posterior wall down to the lower edge of the common hepatic duct. The gallbladder arteries and veins were securely ligated at the gallbladder triangle. The gallbladder plasma membrane was isolated, and the gallbladder was dissected from its bed. The cyst and gallbladder were completely resected at the lower edge of the common hepatic duct, and the lower part of the common hepatic duct was explored to ensure there was no stenosis (Fig. 2B, C). Subsequently, the jejunal entrance was identified, and the gastric branch of the jejunum was grasped with forceps approximately 15 cm from the jejunal entrance, bringing it forward from the peritoneal cavity while isolating the mesentery, and the jejunum was transected; the intestinal wall was incised transversely against the mesenteric border approximately 35 cm from the closed end of the jejuno-hepatic branch, the proximal end of the jejunum was laterally anastomosed with the jejuno-hepatic branch cut-closure device, and then the intestinal tube was closed transversely with the cut-closure device; the mesenteric hiatus was closed with interrupted sutures, and the plasma muscularis layer was sutured with 3 interrupted sutures in juxtaposition between the jejunal-hepatic branch and the gastric branch to prevent reflux, and the intestinal wall was incised transversely against the mesenteric margin about 2 cm from the closed end; and the intestinal tube was also integrated into the peritoneal cavity. The pneumoperitoneum was reconstructed, and an incision of approximately 1 cm was made in the avascular area of the posterior region of the colon. The jejunal-hepatic branch was lifted up through the posterior part of the colon, and the jejunal-hepatic branch was sutured to the lower end of the common hepatic duct with a 4/0 no-knot suture, starting from the left side of the patient, with successive sutures on the posterior wall, followed by successive anastomoses on the anterior wall, and the sutures were closed to close the jejunal-hepatic branch with the transverse mesenteric hiatus. The gap between the jejunohepatic branch and the transverse colonic mesentery was sutured (Fig. 2D), and a drainage tube was left in place.

Fig. 2.

Laparoscopic surgery of choledochal cysts (A) Suspension of the round hepatic igament; (B) Exposing the cyst; (C) Peeling off the cyst; (D) End-to-side hepaticojejunostomy

Intraoperative and postoperative observations and recording indicators

The operation time, intraoperative bleeding, biliary and intestinal anastomosis time, postoperative complications, postoperative abdominal drainage fluid volume, CRP level on postoperative day 7, liver function, and postoperative discharge time were monitored and recorded. Children in both groups were given postoperative cardiac monitoring, monitoring the nature of drainage fluid and recording the drainage volume, nutritional support, and application of antibiotic anti-infection treatment. Discharge was considered only when the patient did not have any discomfort, vital signs were stable, laboratories were normal, and oral feeding was tolerated. Postoperative blood and liver function tests were regularly reviewed to monitor the children’s postoperative recovery. Follow-up for both groups was 3 months.

Statistical analysis

Statistical analysis of the data was conducted using SPSS version 29.0. Categorical variables were expressed as percentages (%), were compared using the chi-square test. Measures that conformed to a normal distribution were presented as (mean ± SD) and compared between groups using the t-test. Conversely, measures that did not conform to a normal distribution were expressed as M (P25, P75) and compared between groups using the Mann-Whitney U test. Differences were considered statistically significant at P < 0.05.

Results

Both patient groups successfully completed the surgery without the need for intermediate open abdomen procedures or secondary surgeries, and no fatalities were reported. The general characteristics of the two groups, including gender, age, weight, cyst diameter, prenatal disgnosis, and preoperative symptom status, showed no statistically significant differences (P > 0.05), indicating comparability as illustrated in Table 1. Additionally, the differences in the general conditions of the two groups prior to surgery were also not statistically significant (P > 0.05, see Table 2).

Table 1.

Comparison of clinical parameters of the patients

Perioperative indicators	RS(n = 32)	LS(n = 35)	χ²/t/z	P value
Sex(M: F)	9:23	10:25	0.191	0.850
Age at surgery (d)	21.17 ± 6.56	20.60 ± 6.06	-0.248	0.805
Weight (kg)	3.75(3.05, 4.64)	3.86(3.25, 4.58)	-0.248	0.805
Diameter (cm)	4.99 ± 1.01	5.10 ± 0.93	-0.097	0.922
Epigastrium cystic mass	9(28.13%)	11(31.43%)	0.087	0.768
Jaundice	12(53.13%)	14(54.28%)	0.032	0.859
Vomiting	6(18.75%)	4(11.43%)	0.838	0.402

Data are presented as M (P25, P75), mean ± SD and %. RS, robotic surgery; LS, laparoscopic surgery; SD, standard deviation

Table 2.

Comparison of preoperative general conditions between the two groups

Variables	RS(n = 32)	LS(n = 35)	χ²/t/z	P value
CRP (mg/L)	11.83 ± 7.37	12.40 ± 7.00	0.782	0.830
WBC (x109/L)	17.61 ± 5.91	16.83 ± 5.97	0.636	0.721
IL-6 (pg/ml)	14.79 ± 8.78	12.52 ± 5.91	0.192	0.385
ALT(U/L)	101.58 ± 36.95	105.55 ± 56.47	0.216	0.830
AST(U/L)	116.75 ± 41.00	120.45 ± 52.23	0.420	0.836
TB(µmol/L)	86.12 ± 45.46	72.53 ± 33.99	0.102	0.343
DB(µmol/L)	42.36 ± 21.79	35.19 ± 16.23	0.249	0.296

Note: Ultrasensitive C-reactive protein (CRP), white blood cells (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB); Data are presented as mean ± SD. RS, robotic surgery; LS, laparoscopic surgery; SD, standard deviation

Among the 67 patients collected, 56 (83.6%) exhibited preoperative clinical symptoms. Specifically, prenatal diagnosis identified an abdominal mass in the right upper abdomen for 20 patients (35.71%); preadmission examinations indicated significant jaundice in 26 patients (46.43%); and 10 patients (17.86%) experienced vomiting, with some presenting with clay-like stools. Further analysis revealed that bilirubin, AST, and ALT levels were elevated in symptomatic patients, as shown in Table 2.

During the surgical procedure, the operation time for the robotic group was longer than that for the laparoscopic group, with a statistically significant difference (P < 0.05). Notably, while the overall intraoperative duration for the robotic group was comparable to that of the laparoscopic group, the time required for biliary-intestinal anastomosis in the robotic group was significantly shorter than that in the laparoscopic group (P < 0.05). Additionally, the robotic group demonstrated superior outcomes compared to the laparoscopic group in terms of postoperative hospitalization duration and intraoperative bleeding, with statistically significant differences (P < 0.05). Furthermore, there was a significant difference in hospitalization costs between the two groups (P < 0.001), as illustrated in Table 3.

Table 3.

Comparison of surgery in the two groups

Variables	RS(n = 32)	LS(n = 35)	χ²/t/z	P value
Total operative time (min)	208.54 ± 10.43	194.54 ± 17.21	0.276	0.016
Intraoperative operative time (min)	179.23 ± 16.10	185.43 ± 13.42	1.174	0.250
Biliary-intestinal anastomosis time (min)	38.25 ± 9.78	52.40 ± 9.83	3.949	<0.001
Intraoperative bleeding (ml)	10.42 ± 2.02	12.65 ± 2.80	2.408	0.022
Postoperative hospital stay (days)	10.25 ± 2.22	12.00 ± 1.95	2.336	0.026
Hospitalization expenses(RMB)	58421.63 ± 3911.63	42183.37 ± 6236.84	-8.086	<0.001

Data are presented as mean ± SD. RS, robotic surgery; LS, laparoscopic surgery; SD, standard deviation

The comparison of postoperative recovery between the two groups indicated that the duration of abdominal drainage and the time to drain removal in the robotic group were significantly shorter than those in the laparoscopic group (P < 0.05). However, there were no statistically significant differences in postoperative fasting time and gastrointestinal function recovery time between the robotic and laparoscopic groups (P > 0.05), as illustrated in Table 4. Table 4 presents a comparison of postoperative outcomes between the RS and LS groups.

Table 4.

Comparison of postoperative outcomes between the RS and LS groups

Postoperative outcomes	RS(n = 32)	LS(n = 35)	χ²/t/z	P value
Postoperative abdominal drainage (ml)	41.17 ± 6.56	50.05 ± 9.04	2.961	0.006
Postoperative fasting time (d)	3.42 ± 0.99	4.25 ± 1.48	1.722	0.095
Gastrointestinal function recovery time (d)	3.00 ± 0.95	3.10 ± 0.97	0.284	0.778
Postoperative fasting time (d)	3.00 ± 0.95	3.10 ± 1.17	0.251	0.804
Time to drainage tube removal (d)	4.33 ± 1.07	5.30 ± 1.13	2.388	0.023

Data are presented as mean ± SD. RS, robotic surgery; LS, laparoscopic surgery; SD, standard deviation

On the seventh day post-surgery, the levels of CRP, WBC, AST, ALT, and other relevant indexes were examined in both groups, revealing no statistically significant differences (P > 0.05). Notably, the bilirubin and liver function indexes of children exhibiting liver function abnormalities and jaundice prior to surgery showed significant improvement following the procedure, with pre-discharge examinations indicating a return to normal values. The two groups were followed up for 3 months after the operation. One patient with biliary fistula complication appeared in the laparoscopic group, which was improved after conservative treatment; no complications occurred in the robotic group, as illustrated in Table 5.

Table 5.

Comparison of complications during postoperative follow-up between the two groups

Postoperative complications	RS(n = 32)	LS(n = 35)	P value
Biliary fistula	0	1(2.9%)	0.335
Blooding	0	0	0
Anastomotic stenosis	0	0	0
Infection	0	0	0
Reoperation	0	0	0
Cholangitis	0	0	0

Values are presented as %;RS, robotic surgery; LS, laparoscopic surgery

Discussion

With advancements in fetal ultrasound and magnetic resonance imaging, the prenatal diagnosis of CCC has increased significantly [13]. Due to the potential risk of serious complications, such as biliary cirrhosis and cyst rupture, some scholars have suggested that surgical treatment should be performed as early as possible after diagnosis to optimize long-term prognosis [14, 15]. In recent years, minimally invasive surgery has become the predominant treatment for CCC, particularly LS, the safety and efficacy of which have been demonstrated in several studies [16, 17]. RS has gradually gained attention in the field of pediatric surgery since Woo [18] and others first reported the use of the Da Vinci RS for the treatment of CCC in children. Originally designed for adults, the Da Vinci robotic system has a large trocar diameter and a standardized surgical hole spacing requirement of ≥ 8 cm, which has limited its application in some infants, particularly in neonatal surgery [19]. Currently, the use of RS in neonates remains limited, with relatively few indications, and there is ongoing controversy regarding its safety and reliability in the treatment of neonatal CCC [20].

The Da Vinci robot offers distinct advantages for patients with small volumes due to its high dexterity and fine manipulation capabilities. The robotic arm can achieve 360-degree rotation and is equipped with a high-definition 3D field of view, which facilitates clear visualization of complex anatomical structures, thereby enhancing the precision of surgical procedures [21, 22]. These features are particularly crucial in neonatal patients, where the surgical space is constrained and a high degree of surgical precision is essential. Our center innovatively optimized the Trocar spacing to 4 cm, successfully addressing the limitations posed by the restricted surgical space in neonates. This study includes sixty-seven neonatal cases of CCC to compare and analyze the clinical efficacy of robotic-assisted surgery versus traditional LS, focusing on the safety and feasibility of robotic-assisted techniques, and evaluating the overall value of this approach in neonatal CCC surgery.

Surgical times for robotic procedures are usually longer than those for laparoscopic procedures [23, 24]. The study data indicated that the total operation time in the robotic group (208.54 ± 10.43 min vs. 194.54 ± 17.21 min) was longer than that in the laparoscopic group, and the total operation time was longer than that reported by Chen’s team [25], which was attributed to the fact that we spent more time on the initial installation and debugging of the robotic system. As a next step, we will continue to optimize the surgical procedure to improve the loading speed and shorten the operation time while refining the teamwork to further improve the stability and safety of the CCC surgical procedure. However, while no significant difference in intraoperative operating time was observed between the two groups, the robotic group demonstrated a notable advantage in the core operation. Specifically, the time required for bilioenteric anastomosis was shorter in the robotic group (38.25 ± 9.78 min) than in the laparoscopic group (52.40 ± 9.83 min), alongside a significant reduction in intraoperative bleeding. Intraoperative bleeding in our robotic group was higher at 10.42 ± 2.02 mL compared to the data reported by Jin [26]. However, intraoperative bleeding in this study was also similar to some studies [27, 28]. This is due to the fact that it is still challenging to perform surgery in neonatal patients with limited abdominal space. Our team will reduce the amount of bleeding by fine dissection, skillful surgical steps, and reducing damage to tissues and blood vessels.

The postoperative hospitalization duration was significantly shorter in the robotic group compared to the laparoscopic group (P < 0.05). This difference may be attributed to the precise dissection and careful tissue protection afforded by RS, which facilitates postoperative recovery by minimizing intraoperative traumatic exudation. This finding aligns with previous literature reports [26]. Although there were no statistically significant differences in postoperative fasting times and gastrointestinal function recovery between the two groups of children, the robotic group demonstrated superior outcomes in terms of postoperative abdominal drainage and drain removal times compared to the laparoscopic group. This suggests that robotic surgery may offer enhanced postoperative recovery for neonates while maintaining equivalence to LS in terms of postoperative management strategies, a conclusion that is consistent with the findings proposed by Yin’s team [29].

Our center successfully performed RS on a low-birth-weight infant with a birth weight of 2350 g. The postoperative abdominal drainage was less than 10 ml per day, allowing for the drain to be removed on postoperative day 4. The infant was subsequently discharged from the hospital on postoperative day 8, with no occurrences of bile leakage, intestinal obstruction, or other complications during the three-month follow-up period. These results demonstrate the feasibility of the Da Vinci robotic system in achieving sub-millimeter anatomical precision within the narrow body cavity of neonates.

In this study, the postoperative liver function and inflammation indexes of children in both groups returned to normal levels, and jaundice improved, further confirming that robot-assisted surgery is safe and reliable for neonatal CCC. Similarly, the robotic group achieved refined biliary-intestinal anastomotic suturing through a three-dimensional visualization system, significantly reducing the occurrence of complications (e.g., biliary fistula) to 0% compared to 2.9% in the laparoscopic group. Chen [9] reported six cases of robotic surgery in neonates without postoperative complications. In this study, no complications were seen in the robotic group while increasing the sample size, demonstrating the feasibility and safety of robotic surgery. Based on the available results, RS not only demonstrates comparable safety to laparoscopy, but its technological features, such as augmented reality navigation and tremor filtering, are more conducive to circumventing anatomical risks specific to neonates, thereby reducing postoperative complications [30]. In fact, the experience and skill of the surgeon will also affect the course of the operation. Our center has gained more experience in neonatal surgery in the previous period, which will reduce the risk of adverse events such as complications and reoperation after skilled surgical intervention.

The limitations of this study include a small sample size of cases and the relatively short follow-up period of three months. Future research should focus on expanding the sample size, conducting continued multicenter studies, and extending follow-up durations to further validate the role of RS in managing neonatal CCC and to explore optimal surgical strategies.

Conclusion

In conclusion, Da Vinci robotic surgery is both safe and reliable for neonatal CCC. This surgical approach offers several advantages, including a short biliary-intestinal anastomosis, minimal tissue injury, and rapid postoperative recovery. These benefits position it as a significant breakthrough in neonatal hepatobiliary surgery, warranting further promotion and application.

Abbreviations

CCC

Congenital choledochal cyst

RS

Robotic surgery

LS

Laparoscopic surgery

Author contributions

We thank Dr. XL, HW, and YL, who were the major contributors in writing the manuscript. Dr. QD, LH, and CT analyzed and interpreted the patient data regarding the congenital choledochal cyst. Dr. ZZ, YG, Z, DZ, and YL for providing samples for this study, and Dr. ZJ for technical assistance. All authors read and approved the final manuscript.

Funding

This work was supported by Qianhe Foundation–ZK[2023] General 555.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and other relevant regulations, approved by the Ethics Committee of Zunyi Medical University (Ethical Review Approval No.: KLL-2025-032), and informed consent was obtained from the children’s families. Informed consents to participate in the study have been obtained from participants and their legal guardians.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.