{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:41:38Z","timestamp":1783024898974,"version":"3.54.6"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T00:00:00Z","timestamp":1660176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Choledochal cysts (CC) are rare disorders characterized by congenital biliary dilatation of the intrahepatic or extrahepatic bile ducts and always relate to pancreaticobiliary maljunction. Robot-assisted surgery has been able to complete almost all pediatric endoscopic surgery nowadays. But evidence of the post-operative outcomes of robotic-assisted operation is limited, comparing with the laparoscopic operation and traditional open operation. The aim of this meta-analysis was to identify the advantages and deficiencies about robotic-assisted operation for CC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A meta-analysis of retrospective studies published in PUBMED, MEDLINE, Web of Science and China National Knowledge Infrastructure (CNKI). No date limit was used, with the last search on April 30, 2022. No publication restrictions or study design filters were applied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine retrospective cohort studies with 1,395 patients [366 in the robotic-assisted operation group (RG), 532 in the laparoscopic operation group (LG) and 497 in the open operation group (OG)] were enrolled in our study. Subgroup analysis demonstrated the RG had significant longer operative time [standardized mean difference (SMD) = 1.59, 95% CI = (0.02, 3.16), <jats:italic>P<\/jats:italic> &amp;lt; 0.05], less blood loss [SMD = \u22121.52, 95% CI = (\u22122.71, \u22120.32), <jats:italic>P<\/jats:italic> &amp;lt; 0.05], shorter enteral feeding time [SMD = \u22120.83, 95% CI = (\u22121.22, \u22120.44), <jats:italic>P<\/jats:italic> &amp;lt; 0.001], shorter time to stay in the hospital [SMD = \u22120.81, 95% CI = (\u22121.23, \u22120.38), <jats:italic>P<\/jats:italic> &amp;lt; 0.001], fewer post-operative complications [Relative risk (RR) =1.09, 95% CI = (1.04, 1.13), <jats:italic>P<\/jats:italic> &amp;lt; 0.001] but higher expenses [SMD = 8.58, 95% CI = (5.27, 11.89), <jats:italic>P<\/jats:italic> &amp;lt; 0.001] than LG. While a significant older age [SMD = 0.46, 95% CI = (0.26, 0.66), <jats:italic>P<\/jats:italic> &amp;lt; 0.001], longer operative time [SMD = 3.96, 95% CI = (2.38, 5.55), <jats:italic>P<\/jats:italic> &amp;lt; 0.001] and shorter time to stay in the hospital [SMD = \u22120.93, 95% CI = (\u22121.62, \u22120.25), <jats:italic>P<\/jats:italic> &amp;lt; 0.05] than OG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Laparoscopic and robotic-assisted procedure are both safe and minimal invasive operational strategies. Robotic-assisted procedure may slowly surpass and has a trend to replace laparoscopy for its advantages. More experiences in robotic-assisted operation should be accumulated for the unexpected complexities, so as to be more stable in the younger age of children.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.968960","type":"journal-article","created":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T07:14:06Z","timestamp":1660202046000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes and comparations of pediatric surgery about choledochal cyst with robot-assisted procedures, laparoscopic procedures, and open procedures: A meta-analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Siqi","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanbin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingkun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianming","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jhbp.415","article-title":"Japanese clinical practice guidelines for congenital biliary dilatation","volume":"24","author":"Ishibashi","year":"2017","journal-title":"J Hepatobiliary Pancreat Sci."},{"key":"B2","first-page":"354","article-title":"Congenital choledochal cyst: video-guided laparoscopic treatment","volume":"5","author":"Farello","year":"1995","journal-title":"Surg Laparosc Endosc."},{"key":"B3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1089\/lap.2006.16.179","article-title":"Robot-assisted laparoscopic resection of a type I choledochal cyst in a child","volume":"16","author":"Woo","year":"2006","journal-title":"J Laparoendosc Adv Surg Tech A."},{"key":"B4","doi-asserted-by":"publisher","first-page":"5009","DOI":"10.1007\/s00464-020-07981-y","article-title":"Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children","volume":"35","author":"Chi","year":"2021","journal-title":"Surg Endosc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"806919","DOI":"10.3389\/fped.2022.806919","article-title":"Trans-umbilical single-site plus one robotic assisted surgery for choledochal cyst in children, a comparing to laparoscope-assisted procedure","volume":"10","author":"Lin","year":"2022","journal-title":"Front Pediatr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"248","DOI":"10.12180\/j.issn.2096-7721.2021.04.002","article-title":"Comparison between robot-assisted and traditional laparoscopic surgery on choledochal cyst excision and hepaticojejunostomy in children","volume":"2","author":"Chi","year":"2021","journal-title":"Chin J Robot Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1007\/s00383-019-04565-3","article-title":"Comparison of robotic versus laparoscopic hepaticojejunostomy for choledochal cyst in children: a first report","volume":"35","author":"Koga","year":"2019","journal-title":"Pediatr Surg Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"3223","DOI":"10.1007\/s00464-020-07560-1","article-title":"Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures: a retrospective study","volume":"34","author":"Xie","year":"2020","journal-title":"Surg Endosc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3349\/ymj.2015.56.3.737","article-title":"Retrospective assessment of the validity of robotic surgery in comparison to open surgery for pediatric choledochal cyst","volume":"56","author":"Kim","year":"2015","journal-title":"Yonsei Med J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.jpedsurg.2020.07.019","article-title":"Clinical efficacy of Da Vinci (SI) robot-assisted choledochal cyst excision in pediatrics","volume":"42","author":"Xie","year":"2021","journal-title":"Chin J Pediatr Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3760\/cma.j.cn421158-20191022-00603","article-title":"A comparative study of Da Vinci robot versus traditional laparoscopy for congenital choledochal cyst in children","volume":"42","author":"Dong","year":"2021","journal-title":"Chin J Pediatr Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"51","DOI":"10.3760\/cma.j.cn.101785-202012066-010","article-title":"Comparative study of Da Vinci technique versus traditional laparoscopic technique in the treatment of choledochal cyst","volume":"21","author":"Cai","year":"2022","journal-title":"J Clin Pediatr Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann Intern Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat Methods Med Res."},{"key":"B16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2690","DOI":"10.1007\/s00464-020-07695-1","article-title":"Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases","volume":"35","author":"Xie","year":"2021","journal-title":"Surg Endosc."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.jpedsurg.2007.06.013","article-title":"Robotic repair of a Bochdalek congenital diaphragmatic hernia in a small neonate: robotic advantages and limitations","volume":"42","author":"Meehan","year":"2007","journal-title":"J Pediatr Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2110","DOI":"10.1016\/j.jpedsurg.2007.08.040","article-title":"The robotic approach to complex hepatobiliary anomalies in children: preliminary report","volume":"42","author":"Meehan","year":"2007","journal-title":"J Pediatr Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1089\/lap.2007.0092","article-title":"Robotic resection of mediastinal masses in children","volume":"18","author":"Meehan","year":"2008","journal-title":"J Laparoendosc Adv Surg Tech A."},{"key":"B21","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1089\/lap.2007.0078","article-title":"Robotic pulmonary resections in children: series report and introduction of a new robotic instrument","volume":"18","author":"Meehan","year":"2008","journal-title":"J Laparoendosc Adv Surg Tech A."},{"key":"B22","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.jpedsurg.2011.09.056","article-title":"Timing of surgery for prenatally diagnosed asymptomatic choledochal cysts: a prospective randomized study","volume":"47","author":"Diao","year":"2012","journal-title":"J Pediatr Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1007\/s00383-014-3461-6","article-title":"One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases","volume":"30","author":"Ngoc Son","year":"2014","journal-title":"Pediatr Surg Int."},{"key":"B24","doi-asserted-by":"publisher","first-page":"103412","DOI":"10.1016\/j.amsu.2022.103412","article-title":"Comparison of outcomes and safety of laparoscopic and robotic-assisted cyst excision and hepaticojejunostomy for choledochal cysts: a systematic review and meta-analysis","volume":"75","author":"Yin","year":"2022","journal-title":"Ann Med Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2803","DOI":"10.1007\/s00464-010-1052-8","article-title":"Initiation of a pediatric robotic surgery program: institutional challenges and realistic outcomes","volume":"24","author":"Sorensen","year":"2010","journal-title":"Surg Endosc."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1007\/s00464-014-3982-z","article-title":"A comparison of robotic surgery in children weighing above and below 15.0 kg: size does not affect surgery success","volume":"29","author":"Ballouhey","year":"2015","journal-title":"Surg Endosc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1089\/end.2013.0733","article-title":"Patient positioning and port placement for robot-assisted surgery","volume":"28","author":"Chang","year":"2014","journal-title":"J Endourol."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.968960\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T07:14:12Z","timestamp":1660202052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.968960\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,11]]},"references-count":27,"alternative-id":["10.3389\/fped.2022.968960"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.968960","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,11]]},"article-number":"968960"}}