Objective:

To evaluate the safety and efficacy of robot-assisted surgery (RS) versus laparoscopic surgery (LS) for pediatric choledochal cysts (CC), addressing the scarcity of comprehensive analyses in existing literature.

Key Findings:

• RS group had significantly lower incidences of postoperative biliary stones (OR = 0.10, 95% CI: 0.01–0.89), bile leakage (OR = 0.28, 95% CI: 0.11–0.70), anastomotic stricture (OR = 0.27, 95% CI: 0.12–0.65), and overall complications (OR = 0.26, 95% CI: 0.13–0.51) compared to LS.
• Total operative time was longer in the RS group (SMD = 1.02; 95% CI: 0.30–1.74), but intraoperative blood loss was significantly lower (SMD = −1.22; 95% CI: −2.19 to −0.24).
• RS group exhibited shorter hepaticojejunostomy time (SMD = −1.43; 95% CI: −2.30 to −0.56), drainage tube indwelling time (SMD = −0.74; 95% CI: −1.01 to −0.47), postoperative fasting time (SMD = −0.80; 95% CI: −1.11 to −0.50), and hospital stay (SMD = −1.16; 95% CI: −2.08 to −0.23).
• No significant differences were found in other outcomes such as postoperative cholangitis (OR = 0.59, 95% CI: 0.22–1.57), residual cyst (OR = 0.22, 95% CI: 0.02–1.94), incision infection (OR = 0.17, 95% CI: 0.02–1.41), intestinal obstruction (OR = 0.97, 95% CI: 0.40–2.33), pancreatitis (OR = 0.74, 95% CI: 0.08–6.47), pancreatic leakage (OR = 0.43, 95% CI: 0.10–1.92), and conversion to open surgery (OR = 0.79, 95% CI: 0.36–1.75).

Interpretation:

RS offers potential advantages over LS in reducing postoperative biliary-related complications and accelerating recovery, despite a longer operative time, which may be mitigated by surgical experience.

Limitations:

• Current evidence is primarily derived from retrospective studies conducted in Asian countries, which may limit generalizability.
• Lack of long-term follow-up data impacts the assessment of outcomes.
• There is a need for well-designed multicenter prospective studies or randomized controlled trials to validate findings and strengthen evidence.

Conclusion:

RS may provide benefits in pediatric CC treatment, but further high-quality research is urgently needed to confirm these advantages and address existing gaps in the literature.