Work

Totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children: clinical outcomes and learning curve

Year: 2026

Type: article

Abstract: Objective To evaluate the feasibility, perioperative outcomes, and learning curve of totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children. Methods We retrospectively reviewed children who underwent laparoscopic choledochal cyst excision between January 2018 and December 2024. Thirty-five children underwent totally single-incision laparoscopic intracorporeal hand-sewn reconstruction (TSILC), and 40 underwent conventional single-incision laparoscopic-assisted reconstruction (SILC). Baseline characteristics, operative outcomes, recovery, complications, and follow-up were compared. Multivariable linear regression with HC3 robust standard errors was used to adjust continuous outcomes for baseline differences. The TSILC learning curve was assessed using cumulative sum (CUSUM) analysis of jejunojejunostomy time. Results TSILC patients were older (29.86 ± 12.99 vs. 19.60 ± 13.62 months, P = 0.001), heavier (14.90 ± 5.07 vs. 9.22 ± 4.40 kg, P < 0.001), and had a different sex distribution ( P = 0.030). After adjustment, total operative time did not differ significantly (adjusted β =8.75 min, 95% CI −12.10 to 29.60; P = 0.411), whereas jejunojejunostomy time remained longer with TSILC (adjusted β=12.02 min, 95% CI 3.02 to 21.02; P = 0.009). TSILC was associated with less blood loss, a shorter incision, and earlier first flatus and defecation (all adjusted P < 0.001); oral intake time did not differ significantly after adjustment ( P = 0.568). Early complications occurred in 3/35 TSILC and 5/40 SILC patients. Thirty-three TSILC procedures were completed without an additional port or open conversion; one required an additional port and one required open conversion. Median follow-up was 40.0 months (IQR 21.5−59.5) for TSILC and 46.5 months (IQR 27.2−66.2) for SILC. The CUSUM curve peaked at case 17, suggesting relative stabilization after case 18. Conclusion TSILC with intracorporeal hand-sewn Roux-en-Y reconstruction was technically feasible in selected children and showed a measurable learning curve. The findings suggest that TSILC may offer perioperative advantages in appropriately selected older and larger children.

Source: Frontiers in Pediatrics

DOI: 10.3389/fped.2026.1951655

Authors: Miao Luo, Zhijie Qin, Yingming Tang, Yize Zhuang

Institutions: Shanghai Jiao Tong University, Shanghai Children's Medical Center

Language: English

Topic: Minimally Invasive Surgical Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801