Comparative Analysis of Robot-Assisted and Laparoscopic Surgery for Pediatric Choledochal Cysts: A Systematic Review and Meta-Analysis

By
Fei Liu
Ke Zhang
April 28, 2026
0 min

Frontiers In Pediatrics

Overview

This systematic review and meta-analysis compare robot-assisted surgery (RS) and laparoscopic surgery (LS) for pediatric choledochal cysts (CC). RS demonstrated significant advantages in reducing postoperative complications and intraoperative blood loss, despite longer operative times.

Background

Choledochal cysts are rare biliary malformations that can lead to severe complications if not treated promptly. Surgical intervention is critical, with radical cyst excision and biliary reconstruction being the standard approach. The evolution of minimally invasive techniques, including robot-assisted surgery, offers potential benefits over traditional laparoscopic methods.

Data Highlights

Outcome	RS	LS	OR/SMD (95% CI)
Postoperative biliary stones	Lower incidence	Higher incidence	0.10 (0.01–0.89)
Bile leakage	Lower incidence	Higher incidence	0.28 (0.11–0.70)
Anastomotic stricture	Lower incidence	Higher incidence	0.27 (0.12–0.65)
Overall complications	Lower incidence	Higher incidence	0.26 (0.13–0.51)
Total operative time	Longer	Shorter	1.02 (0.30–1.74)
Intraoperative blood loss	Lower	Higher	−1.22 (−2.19 to −0.24)

Key Findings

RS significantly reduced postoperative biliary stones, bile leakage, and anastomotic stricture compared to LS.
Overall complications were significantly lower in the RS group.
RS required a longer total operative time but resulted in less intraoperative blood loss.
RS led to shorter postoperative fasting time and hospital stays compared to LS.
No significant differences were found in other postoperative outcomes, including cholangitis and conversion to open surgery.

Clinical Implications

Surgeons may consider robot-assisted surgery for pediatric choledochal cysts due to its potential to reduce postoperative complications and enhance recovery metrics. However, the longer operative time should be weighed against these benefits, particularly in less experienced surgical teams.

Conclusion

Robot-assisted surgery presents notable advantages over laparoscopic surgery for pediatric choledochal cysts, particularly in minimizing complications and improving recovery times. Further prospective studies are needed to validate these findings.