Robotic liver cyst excision: 13 year experience of a paediatric hepatobiliary surgical centre in the UK.

Abstract

Purpose: Non-choledochal non-parasitic liver cysts are uncommon. Increased availability of ultrasound scan has increased the detection of asymptomatic liver cysts. There is paucity of literature on the condition. Most liver cysts are simple and do not require removal. Symptomatic cysts and cysts with the potential of malignant change require surgery. Our study focuses on the efficacy of robotic excision of liver cysts. Method(s): We conducted a retrospective review of patients who underwent robotic liver cyst excision between 2010 and 2023. All procedures were performed using da VinciSurgical System at a single tertiary paediatric hepatobiliary centre. Result(s): Our analysis included 47 patients of which 27% (n = 12) underwent robotic cyst excision at a median age of 3.1 (0.5-11.7) years and weight of 17.2 (5.1-33.8) kg. Median cyst diameter was 5.9 (2.4 -11.7) cm. Indications for surgery included symptoms (n = 3), increased size (n = 4), and presence of septae (n = 5). Histopathology revealed mesenchymal hamartoma (n = 4), ciliated hepatic foregut cysts (n = 4) and simple cysts (n = 4). Early in our experience, two patients required conversion to open surgery, one of which developed the only recorded recurrence. For cases completed robotically, median time to full feeds was 3 (1-5) days, and discharge occurred at 4 (2-6) days. Conclusion(s): Our study comprises the largest series of minimally invasively resected liver cysts. It underscores the safety and feasibility of the robotic approach in well-selected patients. The robotic technique provides superb visualisation with precise instrument control due to the high degree of range of movements facilitating a complete cyst resection.