Child-sized robot gently holding a translucent cyst in a futuristic hospital.

Robotic Surgery for Kids: Is It a Valid Alternative for Cyst Removal?

Kai Mendoza in Health & Wellness June 2025 • 4 min read.

"A new study investigates the rise of robotic surgery for pediatric choledochal cysts, comparing its effectiveness to traditional open surgery and exploring the potential benefits for young patients."

Choledochal cysts (CCs) are congenital conditions where there's an unusual widening in the bile ducts. While relatively rare in Western countries, they're more commonly diagnosed in East Asian nations like Korea, China, and Japan. Often detected in early childhood—or even before birth via prenatal sonography—these cysts carry a significant risk of developing into hepatobiliary malignancies, making timely diagnosis and treatment crucial.

Traditional open surgery (OS) to remove these cysts involves a wide abdominal incision, which can leave a noticeable scar. For many, especially female patients, this is a significant concern. As a result, minimally invasive techniques like robotic surgery (RS) have been gaining traction, offering the potential for smaller incisions and reduced scarring.

While there have been a few studies on robotic surgery for CCs, there's still limited data directly comparing it to open surgery, particularly in pediatric cases. This lack of comprehensive data makes it difficult to definitively say whether robotic surgery is a justifiable alternative for treating CCs in children. To address this gap, a recent study published in the Yonsei Medical Journal aimed to evaluate the outcomes of robotic surgery compared to open surgery in pediatric CC patients.

Robotic vs. Open Surgery: Key Differences & Outcomes

Child-sized robot gently holding a translucent cyst in a futuristic hospital.

The study, conducted at Yonsei University Medical Center, retrospectively analyzed data from 79 pediatric patients with CCs who underwent either robotic surgery (n=36) or open surgery (n=43) between January 2009 and April 2013. All surgeries were performed by a single pediatric surgeon. Parents were allowed to choose which surgical method to use.

The researchers meticulously collected and analyzed a range of preoperative, intraoperative, and postoperative variables. Preoperative data included patient demographics like age, sex, weight, height, and body mass index (BMI). Intraoperative data encompassed operation time, anesthesia time, fluid management, urine output, blood loss, and transfusions. Postoperative data focused on recovery milestones, length of hospital stay, and any complications that arose.

Patient Age: Patients in the robotic surgery (RS) group were significantly older than those in the open surgery (OS) group.
Surgical Duration: Both operation and anesthesia times were longer in the RS group compared to the OS group.
Fluid Management: The RS group required lower fluid input rates to maintain the same urine output as the OS group.
Complication Rates: No significant difference was observed in the American Society of Anesthesiologists (ASA) physical status, length of hospital stay, or the incidence of surgical complications between the two groups.

While the study revealed some key differences between the two approaches, it also highlighted important similarities. Despite the longer operation times associated with robotic surgery, the overall complication rates were comparable to open surgery. This suggests that, even though robotic surgery may take longer, it doesn't necessarily translate to a higher risk of adverse outcomes for pediatric patients with CCs.

The Future of Robotic Surgery for Pediatric CCs

This study provides valuable insights into the potential of robotic surgery as a valid and alternative approach for treating choledochal cysts in children. While early complications can occur as robotic surgical techniques evolve, the results demonstrate that RS can achieve outcomes comparable to traditional open surgery. As robotic surgical systems continue to advance and surgical techniques are refined, future prospective studies are warranted to further explore the benefits of this minimally invasive approach and optimize its application in pediatric CC cases.

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This article is based on research published under:

DOI-LINK: 10.3349/ymj.2015.56.3.737, Alternate LINK

Title: Retrospective Assessment Of The Validity Of Robotic Surgery In Comparison To Open Surgery For Pediatric Choledochal Cyst

Subject: General Medicine

Journal: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

Authors: Na Young Kim, Eun Young Chang, Young Ju Hong, Simin Park, Ha Yan Kim, Sun-Joon Bai, Seok Joo Han

Published: 2015-01-01

Everything You Need To Know

What are choledochal cysts, and why is it important to treat them?

Choledochal cysts, or CCs, are congenital conditions characterized by unusual widening in the bile ducts. These cysts are often detected in early childhood and carry a significant risk of developing into hepatobiliary malignancies. Early diagnosis and treatment, such as through open surgery or robotic surgery, are crucial to address this risk. The location and size of the cyst will determine the best course of action for treatment.

How does robotic surgery compare to traditional open surgery for choledochal cysts, regarding incision size and fluid management?

Traditional open surgery (OS) for choledochal cysts involves a wide abdominal incision to remove the cyst. Robotic surgery (RS) is a minimally invasive technique that uses smaller incisions. A key difference highlighted in the study is that while open surgery has a shorter operative time, robotic surgery often results in less noticeable scarring. In the study, robotic surgery patients required lower fluid input rates to maintain the same urine output as the open surgery group.

What were the main goals and findings of the study comparing robotic surgery and open surgery for pediatric choledochal cysts?

The study compared robotic surgery (RS) and traditional open surgery (OS) for treating choledochal cysts (CCs) in children. It analyzed factors like patient age, surgical duration, fluid management, and complication rates. While robotic surgery took longer, the complication rates were similar to open surgery. The study suggests that robotic surgery is a valid alternative, but further research is needed as surgical techniques evolve.

What were the significant differences found in the study between patients undergoing robotic surgery versus open surgery for choledochal cysts?

The study showed patients in the robotic surgery (RS) group were significantly older than those in the open surgery (OS) group. Both operation and anesthesia times were longer in the RS group compared to the OS group. The RS group required lower fluid input rates to maintain the same urine output as the OS group. No significant difference was observed in the American Society of Anesthesiologists (ASA) physical status, length of hospital stay, or the incidence of surgical complications between the two groups.

Given the comparable outcomes, what future studies are needed to fully understand the role of robotic surgery for pediatric choledochal cysts?

While the study indicates robotic surgery (RS) is a promising alternative to open surgery (OS) for choledochal cysts (CCs) in children, it emphasizes the need for continued research. Future prospective studies are warranted to further explore the benefits of this minimally invasive approach and optimize its application in pediatric CC cases. The long-term outcomes, including recurrence rates and the impact on quality of life, also warrant investigation. As robotic surgical systems continue to advance and surgical techniques are refined, the role of RS in treating pediatric CCs is likely to expand, potentially offering improved outcomes and reduced morbidity compared to traditional open surgery.