Abstract:

Objective To compare the short-term clinical efficacy and safety of multi-arm single-port robotic systems versus multi-port robotic-assisted systems in the treatment of choledochal cysts in children， and to provide reference for clinical practice. Methods A retrospective analysis was conducted on the clinical data of 47 children who underwent robot-assisted laparoscopic cyst excision with Roux-en-Y hepaticojejunostomy at the Affiliated Hospital of Zunyi Medical University， from January 2023 to October 2025. The patients were divided into a single-port group （n = 19） and a multi-port group （n = 28） according to the surgical approach. Perioperative indicators， postoperative pain scores， incision satisfaction， and complications were compared between the two groups. Results No statistically significant differences were observed in baseline characteristics， including sex， age at surgery， body weight， maximum cyst diameter， or incidence of preoperative positive symptoms between the two groups （P > 0.05）. The single-port group showed significantly better outcomes than the multi-port group in terms of time to oral intake ［（2.6 ± 0.5） vs. （3.2 ± 0.6） days］， drainage tube retention time ［（2.3 ± 0.7） vs. （4.7 ± 1.0） days］， postoperative pain score ［（1.6 ± 0.5） vs. （2.2 ± 0.8） points］， and incision aesthetic satisfaction score ［（9.4 ± 0.5） vs. （8.5 ± 0.6） points］ （P < 0.05）. There were no significant differences between the two groups in operative time， intraoperative blood loss， postoperative hospital stay， or complication rate （P > 0.05）. No patient required conversion to open laparotomy. In the multi-port group， two patients developed internal herniation through a transverse mesocolonic defect at 2 and 4 weeks postoperatively， respectively. Both underwent repeat laparoscopic exploration， which revealed no intestinal necrosis； the jejunal loops were reduced to the infra-colonic compartment and the mesenteric defect was sutured closed. Both recovered uneventfully. No serious complications such as bile leakage， pancreatic fistula， intra-abdominal hemorrhage， wound infection， or anastomotic stricture occurred in either group. All patients had normal findings at the 3-month follow-up. Conclusions Both single‑port and multi-port robotic-assisted systems are safe and effective for treating pediatric choledochal cysts. The single-port approach offers advantages in earlier postoperative feeding recovery， better pain control， and superior cosmetic outcomes. However， its long-term efficacy needs to be validated by medium- and long-term follow-up studies.

Key words: choledochal cyst, robotic surgical procedures, single-port multi-arm robots, multi-port robots