Initial experience with 3D laparoscopic choledochal cyst (CDC) excision and hepatico-duodenostomy (HD) in 21 children

Abstract

Introduction: Minimal access surgery has gradually become the standard of care in the management of choledochal cysts (CDC). Laparoscopic management of CDC is a technically challenging procedure that requires advanced intracorporeal suturing skills, and hence, has a steep learning curve. Robotic surgery has advantages of 3D vision, articulating hand instruments making suturing easy and thus is ideal.However, the non-availability, high costs and necessity for large size ports are the major limiting factors for robotic procedures in Paediatric population. Use of 3D laparoscopy incorporates the advantage of 3D vision and at the same time allows the use of small sized conventional laparoscopic instruments. With this background, we discuss our initial experience with the use of 3D laparoscopy using conventional hand instruments in CDC management. Aim: To study our initial experience in management of CDC in paediatric patients with 3D laparoscopy in terms of feasibility and peri-operative details.Materials & Method: All patients under 12 years of age treated for choledochal cyst in a period of initial 2 years were retrospectively analysed. Demographic parameters, clinical presentation, intra-operative time, blood loss, post-operative events and follow-up were studied.Results: The total number of patients were 21. The mean age was 5.3 years with female preponderance.Abdominal pain was the most common presenting symptom. All patients could be completed laparoscopically. No patient needed conversion to open procedure or re-exploration. The average blood loss was 26.67 ml. None of the patients required blood transfusion. One patient developed minor leak postoperatively and was managed conservatively.Conclusion: 3D laparoscopic management of CDC in paediatric age group is safe and feasible. It offers the advantages of depth perception aiding intracorporeal suturing, with use of small sized instruments. It is thus a 'bridging the gap' asset between conventional laparoscopy and robotic surgery. Level of Evidence-Treatment Study level IV HighlightsHepaticoduoenostomy is a known and accepted treatment for choledochal cyst. Using 3D laparoscopy for this reconstructive procedure is the novel technique described here. Ease of performance along with zero requirements of blood transfusions make it our preferred approach in such cases.

Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study

“…Regarding the occurrence of intra-operative complications for excision of heterotopic pancreas, surgeons may face intra-operative technical challenges, such as performing complex and multiple procedures, intracorporeal suturing skills, conversion to open or laparoscopic repair, prolonged operative time and anesthesia time [34][35][36]. In our case series, one neonatal case had malrotation and midgut volvulus with incidental large mesenteric heterotopic pancreas, which was really decision-making dilemmas for surgeons.…”