Totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children: clinical outcomes and learning curve.
- 1Department of Pediatric General Surgery, Shanghai Children's Medical Center Guizhou Hospital, Shanghai Jiao Tong University School of Medicine, Guiyang, China.
Abstract
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. 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. 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. 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.
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BibTeX
@article{luo2026totally,
title = {{Totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children: clinical outcomes and learning curve.}},
author = {Miao Luo and Zhijie Qin and Yingming Tang and Yize Zhuang},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1951655},
url = {https://europepmc.org/article/MED/42952813},
note = {CC BY},
}
RIS
TY - JOUR
TI - Totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children: clinical outcomes and learning curve.
AU - Miao Luo
AU - Zhijie Qin
AU - Yingming Tang
AU - Yize Zhuang
PY - 2026
DA - 2026/10/14
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1951655
UR - https://europepmc.org/article/MED/42952813
AB - 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. 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. 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. 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.
SN - 2296-2360
ER -